- Humana (Springfield, IL)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Springfield, IL)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Humana (Springfield, IL)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Elevance Health (Chicago, IL)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Carelon Medical Benefits Management** **Radiology Benefit** **Management/Utilization** **Review** **Virtual:**… more
- CVS Health (Downers Grove, IL)
- …obtain crucial or required information from Providers, such as HEDIS, Revalidation, Grievance and Appeals , SIU, etc. Coordinate provider status information with ... to support staff. + Process Improvement: Work with Sr. Managers and Director to develop and implement strategies to streamline, policies, procedures, provider… more