• Medical Director - Medicare

    Humana (Atlanta, GA)
    …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
    Humana (08/08/25)
    - Related Jobs
  • Director , Appeals & Grievances

    Molina Healthcare (GA)
    …3 years in a manager role. * Experience with Medicare Regulations, Medicare Duals, Appeals & Grievances , Provider Disputes (Par and Non-Par) and overall ... Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and… more
    Molina Healthcare (07/20/25)
    - Related Jobs
  • Medicare Grievances and Appeals…

    Humana (Atlanta, GA)
    …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
    Humana (06/18/25)
    - Related Jobs
  • Director , Appeals & Grievances

    Molina Healthcare (Macon, GA)
    …Summary** 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… more
    Molina Healthcare (07/18/25)
    - Related Jobs
  • Medical Director (Marketplace)

    Molina Healthcare (Atlanta, GA)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (08/08/25)
    - Related Jobs
  • Licensed Practical Nurse/Licensed Vocational Nurse…

    STG International (Milledgeville, GA)
    …Coordinate Pre-certification sand recertification in accordance with facility policies for Medicare Advantage and + commercial insurance payers. + Interpret the ... coding for accuracy. + Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically… more
    STG International (07/30/25)
    - Related Jobs
  • Provider Contracts Manager

    Molina Healthcare (GA)
    …Tighter knit proximity ongoing after contract. * In conjunction with Director /Manager, Provider Contracts, negotiates Complex Provider contracts including but not ... software. * Targets and recruits additional providers to reduce member access grievances . * Engages targeted contracted providers in renegotiation of rates and/or… more
    Molina Healthcare (07/17/25)
    - Related Jobs