• Director , Grievance…

    Humana (Springfield, IL)
    …for our associates, members and providers. As the Resolution Team Operations Director ( Director , Grievance and Appeals ), you will be accountable for the ... The Resolution team handles all complaints for Humana, including formal grievances, appeals , inquiries and disputes. Our mission is to resolve these complaints… more
    Humana (05/30/25)
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  • Medical Director - National Medicare

    Humana (Springfield, IL)
    …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
    Humana (05/29/25)
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  • Medical Director - Care Plus - Florida

    Humana (Springfield, IL)
    …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
    Humana (04/24/25)
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  • Medical Director - Medicaid N. Central

    Humana (Springfield, IL)
    …not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic ... 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 … more
    Humana (05/14/25)
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  • Associate Medical Director

    Elevance Health (Chicago, IL)
    …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Carelon Medical Benefits Management** **Radiology Benefit** **Management/Utilization** **Review** _A proud… more
    Elevance Health (05/30/25)
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  • Senior Labor Counsel

    TAD PGS, Inc. (Chicago, IL)
    …$128,070 -$156,530 Acts as legal advisor and counsel to the bureau chief or director in all matters related to the statutory authority and execution of powers of ... ; also functions as direct legal aid to the director or bureau chief as required. Aids in interpreting...facts. + Reviews hearing officers' decisions in third-step employee grievance and disciplinary matters. + Oversees matters related to… more
    TAD PGS, Inc. (04/15/25)
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