• 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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  • Nurse Appeals

    Elevance Health (Indianapolis, IN)
    …to Medical Director for final review and decision. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... necessity. + Extrapolates and summarizes medical information for medical director , consultants and other external review. + Research to...skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a… more
    Elevance Health (11/26/25)
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  • Medical Director - Dsnp/MMP

    CVS Health (Tallahassee, FL)
    At CVS Health , we're building a world of health ...UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers ... and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we… more
    CVS Health (11/21/25)
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  • Director of Operations Health DC…

    AmeriHealth Caritas (Washington, DC)
    …Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances , Member Appeals and Grievances , Network adequacy and ... **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the...toward financial sustainability and identify opportunities for improved profitability, health outcomes, and risk adjustment goals; directs analytical activities… more
    AmeriHealth Caritas (10/28/25)
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  • Associate Medical Director

    UCLA Health (Los Angeles, CA)
    …+ Provide clinical determinations for UM (prior authorizations, concurrent reviews, appeals , grievances , peer-to-peer). + Support day-to-day UM and Clinical ... medicine and improving care for Medicare Advantage members? UCLA Health Medicare Advantage Plan is looking for a dedicated...is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan.… more
    UCLA Health (11/16/25)
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  • Medical Director Managed Care Physician…

    Dignity Health (Bakersfield, CA)
    …efficiency, and address impactable variation. - Serve as the physician medical director for the Population Health Services Organization (PHSO) quality division. ... of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other related duties. **Job Requirements**… more
    Dignity Health (10/17/25)
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  • Senior Director of Quality Assurance…

    Washington County Mental Health Services (Barre, VT)
    Senior Director of Quality Assurance and Compliance Washington County Mental Health Services is seeking an experienced Senior Director of Quality Assurance ... Identify and mitigate compliance and quality risks through proactive measures, manage Grievances and Appeals processes, and conduct routine assessments of… more
    Washington County Mental Health Services (11/06/25)
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  • Member Intake Admin - Worcester Office based…

    Fallon Health (Worcester, MA)
    …or follow us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's ... be able to type 25 WPM.** **About us:** Fallon Health is a company that cares. We prioritize our...departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible… more
    Fallon Health (11/20/25)
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  • Medical Director

    Molina Healthcare (Tampa, FL)
    …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (10/17/25)
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  • Director Of Labor And Employee Relations

    City of New York (New York, NY)
    …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy… more
    City of New York (11/12/25)
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