• IRE Grievance & Appeals Mgr II

    Elevance Health (FL)
    **Manager II Grievance / Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... an accommodation is granted as required by law._ The **Manager II Grievance / Appeals ** responsible for management oversight of grievances and appeals more
    Elevance Health (07/15/25)
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  • Director, Appeals & Grievances (Medicare)

    Molina Healthcare (St. Petersburg, FL)
    …Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving ... in line with state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the key performance requirements.… more
    Molina Healthcare (07/20/25)
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  • Director, Appeals & Grievances (Medicare…

    Molina Healthcare (Jacksonville, FL)
    …Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager ... and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals / grievance and/or claims processing within a managed care setting.… more
    Molina Healthcare (07/18/25)
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  • Director, Medicare Administration (Regulatory SME)…

    Molina Healthcare (Tampa, FL)
    …procedures regarding compliance with local, state and federal guidelines. + Establishes member grievance appeals and policies and updates annually or as directed ... for Medicare and Medicaid Services. + Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the… more
    Molina Healthcare (06/15/25)
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  • Medical Director - Mid West Region

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

    Humana (Tallahassee, FL)
    …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for… more
    Humana (07/11/25)
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  • Innovation Product Manager

    CVS Health (Tallahassee, FL)
    …(PO) is responsible for leading the Medicare innovation product development for the Grievance & Appeals (G&A) Department. This role contributes to the product ... vision and translates it for the product development team. They are responsible for team backlog development and prioritization, maintaining integrity of features or components, and collaborating closely with Engineering, Design, and other stakeholders. They… more
    CVS Health (07/19/25)
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  • Medical Director - NorthEast Region

    Humana (Tallahassee, FL)
    …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
    Humana (07/25/25)
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  • Sr Analyst, Business

    Molina Healthcare (FL)
    …Management + Experience working with complex, often highly technical teams + Appeals & Grievance , healthcare services, or claims background **Preferred License, ... Certification, Association** Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred To all current Molina employees: If you are interested in applying for this position, please apply through… more
    Molina Healthcare (07/17/25)
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  • Specialist, Appeals & Grievances (Medicare…

    Molina Healthcare (FL)
    …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes,… more
    Molina Healthcare (06/26/25)
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