• Corporate Medical Director…

    Humana (Des Moines, IA)
    …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate… more
    Humana (04/24/25)
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  • Medical Director - Medicare…

    Humana (Des Moines, IA)
    …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
    Humana (05/14/25)
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  • Director , Appeals & Grievances…

    Molina Healthcare (Des Moines, IA)
    …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... activities of the Appeals & Grievances unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized… more
    Molina Healthcare (05/16/25)
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  • Medical Director ( Medicare )

    Molina Healthcare (Davenport, IA)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (05/02/25)
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  • Medical Director Specialty…

    Molina Healthcare (Des Moines, IA)
    **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +...Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
    Molina Healthcare (04/09/25)
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  • Financial Counselor

    Mary Greeley Medical Center (Ames, IA)
    …and meet regulatory requirements. + Reports any observed or suspected deviation from medical center policies or from Medicare , Medicaid, or other insurance ... regulations immediately to the department Manager, Director , or the medical center's Compliance Officer....Compliance Officer. + Reports any concerns regarding patient care grievances to the Manager or Director . +… more
    Mary Greeley Medical Center (05/17/25)
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  • Provider Contracts Manager

    Molina Healthcare (IA)
    …Tighter knit proximity ongoing after contract. * In conjunction with Director /Manager, Provider Contracts, negotiates Complex Provider contracts including but not ... software. * Targets and recruits additional providers to reduce member access grievances . * Engages targeted contracted providers in renegotiation of rates and/or… more
    Molina Healthcare (04/30/25)
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