- Humana (Baton Rouge, LA)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- DEPUTY DIRECTOR OF ELIGIBILITY (MEDICAID DEPUTY DIRECTOR ) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5062744) Apply DEPUTY ... DIRECTOR OF ELIGIBILITY (MEDICAID DEPUTY DIRECTOR ) Salary $7,540.00 - $14,792.00 Monthly Location Baton Rouge, LA Job Type Classified Job Number MVA/PJ/212444… more
- Humana (Raleigh, NC)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- Oregon State University (Corvallis, OR)
- …for responding to the concerns of disabled students per the DAS grievance / appeals procedures. + Mediates disability-related academic issues between faculty and ... & Compl Job Title Assistant Dean of Students and Director of Disability Access Services Appointment Type Professional Faculty...Services is seeking an Assistant Dean of Students and Director of Disability Access Services. This is a full-time… more
- Elevance Health (Mason, OH)
- …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 Benefits Management** **Radiology Benefit** **Management/Utilization** **Review** **Virtual:**… more
- UPMC (Pittsburgh, PA)
- …or Emergency Medicine 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
- Transdev (North Las Vegas, NV)
- …The Labor Relations Manager provides support to the Area General Manager, Director of Human Resources, and Operations Teams on labor relations projects, priorities ... ensure consistency in language and interpretation of collective bargaining agreements, grievance management, and arbitration preparation. Transdev is proud to offer:… more
- Humana (Springfield, IL)
- …with Medicaid or DSNP Members. + Knowledge and/or experience in working with grievance and appeals . + Intermediate to advanced knowledge of Microsoft Office ... strategies on matters of significance, and lead execution of member grievance and appeal trends, working closely with cross-departmental management. + Partners… more