- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
- CareFirst (Baltimore, MD)
- …in a managed care or health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances . **Preferred Qualifications:** + ... + Understanding of the interdependencies between Medical Policy, Clinical Medical Review and Appeals and Grievances . + Ability to mentor and coach… more
- Elevance Health (Hendersonville, TN)
- …Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are ... for medical necessity. + Extrapolates and summarizes medical information for medical director ,...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
- Elevance Health (Rancho Cordova, CA)
- …Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are ... for medical necessity. + Extrapolates and summarizes medical information for medical director ,...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
- Highmark Health (Charleston, WV)
- …and providers across the network. + Attend meetings as appropriate, including medical director meetings, QI committee and subcommittees, as assigned. + ... ongoing relationships with the corporation maximize their effectiveness. + Grievances and Appeals - Assist in the...There are a variety of external contacts that the Medical Director would be anticipated to regularly… more
- LA Care Health Plan (Los Angeles, CA)
- Medical Director , Medical Management Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... net required to achieve that purpose. Job Summary The Medical Director , Medical Management, is...of care, complex care rounds, interdisciplinary care team rounds, appeals and grievances and provider disputes. On… more
- CVS Health (Columbus, OH)
- …resistant illnesses through peer review and educational interventions.* Work with medical director teams focusing on inpatient care management, clinical ... coverage review, member appeals clinical review, medical claim review, and...the investigation of potential quality of care concerns and/or grievances * Actively support compliance functions to maintain standardized systems,… more
- UPMC (Moosic, PA)
- We have an exciting opportunity for a full-time Senior Medical Director to join our leadership team with UPMC Community Care! As Senior Medical Director , ... you to learn more and apply today! The Senior Medical Director provides guidance for clinical operational...with the Counties and DHS + Reviews complaints and grievances in accordance with Community Care procedures and ensures… more
- Guardian Life (Plano, TX)
- …applicable state regulations. In this role, you will ensure that referrals, appeals , and grievances meet state specific regulations, timeframes, and definitions ... The **Texas State Dental Director ** will be responsible for ensuring that professional...the regulators. You will Review Specialty Referrals, Claims & Appeals + Review & ensure that determination and processing… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... related to denial prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician review of utilization,… more