- CVS Health (Hartford, CT)
- …in the US. Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both provider and ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- CVS Health (Nashville, TN)
- …Medicine or Internal Medicine / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … more
- Humana (Frankfort, KY)
- … (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the… more
- Molina Healthcare (Des Moines, IA)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance ... * Leads, organizes, and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and...a manager role. * Experience reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims, Surgery,… more
- Molina Healthcare (St. Petersburg, FL)
- **Job Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for ... etc. * Provides direct oversight, monitoring and training of provider disputes and appeals to ensure adherence with Medicare standards and requirements related… more
- Humana (Little Rock, AR)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Mayo Clinic (Rochester, MN)
- …such situations successfully. Travel required as assignments warrant. **Position Overview** The Director of Clinical Appeals will serve as a strategic and ... can build a long, successful career with Mayo Clinic. **Benefits Highlights** + Medical : Multiple plan options. + Dental: Delta Dental or reimbursement account for… more
- Henry Ford Health System (Troy, MI)
- …(DOL) and Center for Medicare /Medicaid Services (CMS). Maintain formal history of provider appeals and the medical component of Member appeals to utilize ... General Summary: The Clinical Manager, Medical Appeals supports appeals ...appeals , for all product lines (HMO, AHL, and Medicare Advantage (MA), Medicaid, and Duals) in accordance with… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- Humana (Olympia, WA)
- **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...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more