• Director , Appeals…

    Sanford Health (Sioux Falls, SD)
    …related field required. Master's degree preferred. Minimum of 7 years of experience in health plan appeals and grievances , regulatory oversight, or health ... Strong knowledge of CMS, Medicaid, ACA, and Commercial appeals and grievances regulations. **Benefits** Sanford Health offers an attractive benefits package… more
    Sanford Health (09/29/25)
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  • Corporate Medical Director - Medicare…

    Humana (Pierre, SD)
    …The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and… more
    Humana (09/05/25)
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  • Medical Director - Medicare…

    Humana (Pierre, SD)
    …first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
    Humana (10/02/25)
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  • Part-Time Weekend Medical Director (Remote)

    Highmark Health (Pierre, SD)
    …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... + None **Preferred** + Master's Degree in Business Administration/Management or Public Health **EXPERIENCE** **Required** + 5 years in Clinical, Direct Patient care… more
    Highmark Health (09/11/25)
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