• Director , Grievance…

    Humana (Raleigh, NC)
    …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 - Florida

    Humana (Raleigh, NC)
    …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 (06/05/25)
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  • Medical Director - Care Plus - Florida

    Humana (Raleigh, NC)
    …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 -Payment Integrity

    Humana (Raleigh, NC)
    …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...of care received. May also engage in disputes and grievance and appeals reviews. May participate on… more
    Humana (06/06/25)
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  • Medical Director - Medicaid N. Central

    Humana (Raleigh, NC)
    …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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  • Manager PACE Quality and Compliance

    HCA Healthcare (Asheville, NC)
    …for over sight of the Contract Liaison, HIMS Clerk and Service Delivery, Appeals and Grievance (SDAG) Coordinator. **What qualifications you will need:** ... CarePartners PACE. The Quality and Compliance Manager, in conjunction with the Medical Director , is responsible for developing the QAPI annual plan, and guiding the… more
    HCA Healthcare (06/03/25)
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