- 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
- Dignity Health (Rancho Cordova, CA)
- **Job Summary and Responsibilities** The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal ... and maintaining patient confidentiality (HIPAA) are also essential. Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective… more
- 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 (Tampa, FL)
- …appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non… more
- Elevance Health (Columbus, OH)
- …appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + Documents ... entities. + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non… more
- 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
- 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
- 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
- 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
- Point32Health (MA)
- **Who We Are** Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving ... nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier… more