- 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 (Hartford, CT)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Part C Medicare Appeals . This position is ... however the expectation is to cross train for regulated appeals . * Provide support to Medicare appeal...Specialty Preferred Qualifications * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Topeka, KS)
- … (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
- Commonwealth Care Alliance (Boston, MA)
- …recommendations to either uphold or deny appeal and forwards to Medical Director as needed. + Ensures that appeals and grievances are resolved timely ... Exercised:** + None **Essential Duties and Responsibilities:** + Extrapolates and summarizes medical information for medical director , consultants, and other… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals...meetings. 6. Routinely meets with underpayment team manager and director to provide updates on KPI's. 7. Research and… more
- Elevance Health (Walnut Creek, CA)
- ** Medical Director - Medicare and...the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... and skill development. Candidates must live in California. The ** Medical Director ** will be responsible for utilization...will be responsible for utilization review case management for Medicare and Medicaid in the California market while also… more
- Centene Corporation (Jefferson City, MO)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical… more
- Humana (Dover, DE)
- **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
- Humana (Charleston, WV)
- **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
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