- Sanford Health (Sioux Falls, SD)
- …or regulatory review functions. Strong knowledge of CMS, Medicaid, ACA, and Commercial appeals and grievances regulations. **Benefits** Sanford Health offers an ... oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA,… more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding ... or their respective auditors JOB DUTIES AND RESPONSIBILITIES: + Conduct retrospective medical record reviews for clinical validation of diagnosis and procedure code… more
- Elevance Health (Morristown, NJ)
- **Plan Performance Medical Director - New York Commercial ** Location: This role enables associates to work virtually full-time, with the exception of required ... Medical Director ** serves as the Chief Medical Officer for the health plan's Commercial ...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- CVS Health (Springfield, IL)
- …portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs...(Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. - Medical Directors will… more
- Humana (Juneau, AK)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CenterWell (Boston, MA)
- **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health ... claims. The Medical Director , Primary Care work assignments involve moderately complex to...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations,… more
- Humana (Indianapolis, IN)
- **Become 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 work assignments involve moderately complex to complex issues...managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations,… more
- CVS Health (Austin, TX)
- …of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy ... CVS Health company, has an outstanding opportunity for a Medical Director . Ready to take your career...of Aetna clinical and coding policy and experience with appeals , claim review, reimbursement issues, and coding is preferable,… more
- Elevance Health (Denver, CO)
- **Behavioral Health Medical Director - Child Psychiatrist** Location: This role enables associates to work virtually full-time, with the exception of required ... be considered. Schedule: Fulltime position, Monday through Friday. The **Behavioral Health Medical Director - Child Psychiatrist** is responsible for completing … more
- Robert Half Finance & Accounting (Carlisle, PA)
- Description We are looking for a dedicated Revenue Cycle Management Director to lead and manage all aspects of our client's revenue cycle operations. This position ... * Oversee the revenue cycle processes for Medicaid, Medicare, managed care, commercial payers, and sliding fee programs. * Establish and enforce billing policies… more