- Humana (Columbus, OH)
- …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 (Columbus, OH)
- …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 (Columbus, OH)
- …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
- Elevance Health (Columbus, OH)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual:**...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Humana (Columbus, OH)
- …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
- Elevance Health (Mason, OH)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Associate Medical Director ** **Interventional Pain** **Carelon Medical Benefits Management** **Virtual:** This role enables associates to work… more
- Elevance Health (Independence, OH)
- Job Description **LTSS Director - Planning & Strategy Lead** **(** **Strategy & Prog Dev Dir** **ector)** **_Preferred Location: Ohio. This position is hybrid and ... health, long term services and supports, and psychosocial needs._ The **LTSS Director - Planning & Strategy Lead** is responsible for providing strategic leadership… more