- 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 part ... AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... experience in a Managed Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will have:** + Proven experience… more
- LA Care Health Plan (Los Angeles, CA)
- …required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory ... (15%) Maintain the monthly reporting responsibilities, Appeals and Grievance reporting to Department Director , ongoing referrals and authorizations… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... This position will work with department Supervisors, Managers and Director for all problems related to quality improvements as...the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB… 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
- Humana (Jackson, MS)
- …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 health claims....member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver,… more
- Sharp HealthCare (San Diego, CA)
- …and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp Health Plan's (SHP) ... 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - Medical...data of paid claims, encounters, authorization logs, complaint and grievance logs and other sources. + Achieves and maintains… 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
- Humana (Austin, TX)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews and/or condition committees. Travel: While this is ... community and help us put health first** The Dental Director is responsible for providing clinical oversight to promote...This is accomplished by analysis and adjudication of claims, appeals , and potential quality of care issues. The Dental… more