- Sharp HealthCare (San Diego, CA)
- …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify ... business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp...trends in grievances . Supervises the process for identifying Potential Quality Issues.… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …on the Administration of BH QM/UM and performance improvement activities, including grievances and appeals . + Attendance at regular (at least quarterly) ... care system. + Develops, conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care, as… more
- CVS Health (Tallahassee, FL)
- …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical coverage review, member… more
- Somatus (Mclean, VA)
- …physical and mental well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality, is responsible for ... of business including Commercial, Medicaid, Medicare, and Special Need Plans (SNPs). The Director , Quality will work closely with Sr. Manager, Audit Risk and the… more
- Molina Healthcare (WI)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Trinity Health (Gaithersburg, MD)
- …all activities pertaining to complaints, service delivery requests, and grievances / appeals , assures regulatory compliance and incident reporting including ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Director , Quality, Improvement and Compliance** **Location:** Trinity Health PACE of… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical...in grievances . Supervises the process for identifying Potential Quality Issues.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …inpatient/concurrent reviews, outpatient, and retrospective reviews, Physician reviews and Appeals and Grievances processing. Primary Responsibilities + ... About The Role The Director , Utilization Management (UM) will manage the Utilization...of Clinicians and Non-Clinical support staff from Intake through Appeals processing. The ideal candidate will have a strong… more
- University of Miami (Coral Gables, FL)
- …review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Director , Faculty Affairs supports the Vice Provost for ... and leading process improvement initiatives for the OFA. The Director engages with the Vice Provost for Faculty Affairs,...Assists the Vice Provost in managing salary review and appeals . + Reviews and process Coral Gables and Rosenstiel… more
- Dairy Farmers of America (Kansas City, KS)
- …problems, such as working conditions, disciplinary actions, and employee and applicant appeals and grievances + Evaluate and assist with effective resolution ... of grievances and other local conflicts resulting from labor agreements + Develop and maintain effective relationships with union leadership to foster and… more