• Specialist, Appeals & Grievances

    Molina Healthcare (IA)
    …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
    Molina Healthcare (08/01/25)
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  • Director, Appeals & Grievances (Medicare)

    Molina Healthcare (Sioux City, IA)
    …requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with federal and state ... trends and prepares reports that identify root causes for Appeals, Grievances , and Provider Disputes. Recommends and implements process improvements to achieve… more
    Molina Healthcare (07/20/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Cedar Rapids, IA)
    …that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes. + ... Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina… more
    Molina Healthcare (08/01/25)
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  • Medical Director - Medicare Grievances

    Humana (Des Moines, IA)
    …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
    Humana (08/08/25)
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  • Director, Appeals & Grievances (Medicare…

    Molina Healthcare (Des Moines, IA)
    …Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the ... standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for… more
    Molina Healthcare (07/18/25)
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  • Medicare Grievances and Appeals Corporate…

    Humana (Des Moines, IA)
    …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
    Humana (06/18/25)
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  • Director, Operational Oversight (Medicare/Duals)…

    Molina Healthcare (Davenport, IA)
    …must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You surface systemic issues, ... Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic defects. 3. Capabilities… more
    Molina Healthcare (07/13/25)
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  • HS Assistant Girls Soccer

    Carlisle Community School District (Carlisle, IA)
    …the proper administrative line of command and refers all requests or grievances through proper channels. Is aware of all public/staff/departmental meetings that ... analyzes staff effectiveness and evaluates all assistants. 7. Maintains discipline, adjusts grievances and works to increase morale and cooperation. 8. Performs such… more
    Carlisle Community School District (08/08/25)
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  • Sr Specialist, Member Engagement (Remote)

    Molina Healthcare (Sioux City, IA)
    …in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the development/maintenance of Member ... advocate organizations, subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of… more
    Molina Healthcare (08/02/25)
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  • HS Head Boys Soccer Coach

    Fort Dodge Community School District (Fort Dodge, IA)
    …the proper administrative line of command and refers all requests or grievances through proper channels. Is aware of all public/staff/departmental meetings that ... programs, services, and its employment practices. If you have questions or grievances related to this policy, please contact Roger Porter, Director of School… more
    Fort Dodge Community School District (08/01/25)
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