- Sharp HealthCare (San Diego, CA)
- …physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical Board of CA ... from summary data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains benchmarked utilization… more
- Elevance Health (Houston, TX)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Home Health Utilization Review** **Carelon Medical Benefit Management** **Virtual:** This role enables… more
- Elevance Health (Costa Mesa, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Carelon Medical Management** **Outpatient Rehab Utilization Management** **Virtual:** This role enables… more
- Elevance Health (Atlanta, GA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Medical Director ** **Carelon MBM** **Virtual:** This role enables associates to work virtually full-time, with the exception of required… more
- Dairy Farmers of America (Kansas City, KS)
- …negotiate contracts, interpret the collective bargaining agreements, and administer grievance procedures and arbitrations. Provide expertise and guidance on labor ... problems, such as working conditions, disciplinary actions, and employee and applicant appeals and grievances + Evaluate and assist with effective resolution of… more
- UPMC (Pittsburgh, PA)
- …a board-certified physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC Community Health Choices. This role is fully ... between 8am - 4pm EST, in order to attend grievance hearings. One of the perks of this position...weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality,...Commercial, Medicaid, Medicare, and Special Need Plans (SNPs). The Director , Quality will work closely with Sr. Manager, Audit… more
- Molina Healthcare (Phoenix, AZ)
- …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
- Transdev (Readville, MA)
- …The Labor Relations Manager provides support to the General Manager and Director of Human Resources on labor relations projects, priorities and issues. This ... + Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and… more
- Johns Hopkins University (Baltimore, MD)
- …Office of Employee and Labor Relations. This position will report, to the Director of Employee Relations and Labor Relations (ER/LR). This position will provide a ... actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer,… more
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