- 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
- 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,...(Mid.) - $107,498.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by… more
- AmeriHealth Caritas (Newark, DE)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Humana (Topeka, KS)
- …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 (Olympia, WA)
- …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
- UPMC (Pittsburgh, PA)
- …board-certified physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC Community Health Choices. This role is fully ... choose their weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
- Sharp HealthCare (San Diego, CA)
- …more years of clinical practice of medicine. + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons License - Medical ... **Facility:** Health Plan **City** San Diego **Department** **Job Status**...as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care… more
- 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 ... **Facility:** Health Plan **City** San Diego **Department** **Job Status**...a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical… 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
- Trinity Health (Pensacola, FL)
- …all activities pertaining to complaints, service delivery requests, and grievances / appeals , assures regulatory compliance and incident reporting including ... the PACE Organization (PO) and ensure overall CMS regulatory compliance. The Director , Quality Improvement and Compliance, in collaboration with the Medical … more