• Director , Appeals…

    Molina Healthcare (Kenosha, WI)
    …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving...monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
    Molina Healthcare (09/26/25)
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  • Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Appeals & Grievances Location: Los Angeles, CA,...This position will work with department Supervisors, Managers and Director for all problems related to quality improvements as… more
    LA Care Health Plan (08/29/25)
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  • Corporate Medical Director - Medicare…

    Humana (Topeka, KS)
    …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope ... 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 (Olympia, WA)
    … Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services… more
    Humana (10/02/25)
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  • Medical Director , Grievances

    UPMC (Pittsburgh, PA)
    …seeking a board-certified physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC Community Health Choices. This role is ... choose their weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
    UPMC (09/28/25)
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  • Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify ... business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp...trends in grievances . Supervises the process for identifying Potential Quality Issues.… more
    Sharp HealthCare (07/19/25)
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  • Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical...in grievances . Supervises the process for identifying Potential Quality Issues.… more
    Sharp HealthCare (08/17/25)
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  • Remote Director of Health Plan…

    Insight Global (Norfolk, VA)
    Job Description Insight Global is looking for a Remote Director of Health Plan Business Testing for a large healthcare company. This individual must reside in ... one of the approved remote states listed below. This candidate will lead all...Claims, Encounters, Benefits Configuration, Claims & Pricing Configuration, Enrollment, Appeals & Grievances , and Contact Center/Customer Service.… more
    Insight Global (09/09/25)
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  • Part-Time Weekend Medical Director…

    Highmark Health (Dover, DE)
    …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more
    Highmark Health (09/11/25)
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  • Assistant Dean of Students and Director…

    Oregon State University (Corvallis, OR)
    …Administrator 2-Contr & Compl Job Title Assistant Dean of Students and Director of Disability Access Services Appointment Type Professional Faculty Job Location ... Corvallis Benefits Eligible Full-Time, benefits eligible Remote or Hybrid option? Job Summary Disability Access Services...Services is seeking an Assistant Dean of Students and Director of Disability Access Services. This is a full-time… more
    Oregon State University (09/23/25)
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