• Grievances and Appeals 3

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
    Humana (09/09/25)
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  • Coordinator, Appeals and Grievances

    Evolent (Tallahassee, FL)
    …for the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator** **,** ** Appeals and Grievances ** at Evolent will serve as a point of contact ... for processing post determination reviews and appeals requests in accordance with departmental policies, regulatory requirements,...A high school diploma or GED is required. + 3 years of experience in an Intake Coordinator role… more
    Evolent (09/05/25)
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  • Appeals & Grievance Specialist (remote)

    Cognizant (Tallahassee, FL)
    …any qualified applicant in the United States. **Job Summary:** We are seeking a dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join ... processes to improve efficiency and patient satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify… more
    Cognizant (09/09/25)
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  • Director, Operational Oversight (Medicare/Duals)…

    Molina Healthcare (St. Petersburg, FL)
    …and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You ... 2. Workflow Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic… more
    Molina Healthcare (08/19/25)
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  • Medical Director - Dsnp/MMP

    CVS Health (Tallahassee, FL)
    …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals … more
    CVS Health (09/04/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (St. Petersburg, FL)
    …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (08/28/25)
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