• Grievance & Appeals Representative

    Humana (Nashville, TN)
    …comprehensive analytic review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then delivers final determination ... + Previous inbound call center or related customer service experience​ + Grievance and appeals experience + Prior experience interpreting Member Benefits and Medical… more
    Humana (09/02/25)
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  • Medical Director - Mid West Region

    Humana (Nashville, TN)
    …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
    Humana (08/08/25)
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  • Associate Medical Director - Interventional Pain

    Elevance Health (Nashville, TN)
    …determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use ... of medical policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD or DO and Board certification… more
    Elevance Health (09/03/25)
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  • Nurse Appeals RN

    Elevance Health (Nashville, TN)
    …are resolved timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems. + Generates ... written correspondence to providers, members, and regulatory entities. + Utilizes leadership skills and serves as a subject matter expert for appeals/grievances/quality of care issues and is a resource for clinical and non clinical team members in expediting… more
    Elevance Health (09/03/25)
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  • Case Manager RN

    HCA Healthcare (Hermitage, TN)
    …discharge criteria. Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights and responsibilities. + ... You will act as the coordinator of patient/family/caregiver education. You will promote the participation of the patient/family/caregiver in team discussions related to plans, goals, and status. This will be conducted through Family Conferences and other… more
    HCA Healthcare (08/24/25)
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  • Medicare Sales Account Representative

    BrightSpring Health Services (Knoxville, TN)
    …Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals. + Actively market plan to new senior care partners within ... plan Service Area. + Assist with identifying key providers in market area that would enhance plan's network. + Meet the physical and sensory requirements stated below and be able to work in the described environment. + Responsible for year-round enrollment of… more
    BrightSpring Health Services (08/14/25)
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  • RN Clinical Operations Specialist - Home Health…

    Maxim Healthcare (Knoxville, TN)
    …+ In consultation with office leadership (clinical and operations) assist in grievance concerns, reports and issues + In consultation with office leadership ... (clinical and operations) assist in incident report management , trending and analytics + Initiates creative work flow process improvement + Participates in office based meetings including staff meetings, quality meetings and red zones + On a quarterly basis… more
    Maxim Healthcare (08/12/25)
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  • Behavioral Health Medical Director - Medicare

    Humana (Nashville, TN)
    …in meetings involving care management, provider relations, quality of care, audit, grievance and appeal and policy review. The Behavioral Health Medical Director ... will develop and present educational seminars on various behavioral health topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios,… more
    Humana (08/09/25)
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  • Restaurant General Manager

    Carrols Corporation (Harriman, TN)
    …all employee relations and personnel actions (ie, timely performance evaluations, grievance handling, disciplinary actions, employee counseling, etc.) in order to ... develop attitudes of cooperation, enthusiasm and professionalism. + Complete, approve, submit and maintain files on all internal records and reports as required by law and company policy. + Train and develop the capabilities of Assistant Managers and Manager… more
    Carrols Corporation (08/08/25)
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  • Chief Executive Officer

    Select Medical (Memphis, TN)
    …+ Complies with regulatory obligations and possesses ownership of the Complaint- Grievance Process. + Ensures hospital's overall compliance with State, Federal, and ... JCAHO regulations. + Focuses on employee engagement. + Personally creates, continually cultivates and owns a Top 10 Key Business Development Relationship list. + Knows, understands and effectively implements the Corporate Case Management and PPS Model. +… more
    Select Medical (08/08/25)
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