- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is excited to announce that we are hiring **Work from Home Appeals and Grievance Specialists** . The Appeals and Grievance ... a key role in helping members navigate and understand their benefits related to Appeals , External Medical Review, and the Fair Hearing process. Acts as the first… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …knowledge of all aspects of managed care medical management including UM/CM, Grievance and Appeals , inpatient and outpatient services, medical policy, and ... and cares for more than 580 participants. We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent,… more
- Sanford Health (Sioux Falls, SD)
- …strategic oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, ... adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- CVS Health (Hartford, CT)
- …remote based (work at home) based anywhere in the US. **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on ... AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly… more
- Elevance Health (Tampa, FL)
- …+ Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved ... **Nurse Appeals ** **Hybrid 1:** This role requires associates to...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- CenterWell (Boston, MA)
- …of the role includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Providence, RI)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Raleigh, NC)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on… more
- Humana (Carson City, NV)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...and care received. May also engage in disputes and grievance and appeals reviews. May participate on… more
- City of New York (New York, NY)
- …planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy ... arise with CFB employees. - Serve as the CFB's grievance representative and administer the contractual grievance ...process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the Office… more
