- Humana (Columbus, OH)
- …Medical 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… more
- CareFirst (Baltimore, MD)
- …health insurance environment with a focus on Clinical Medical Review and Appeals and Grievances . **Preferred Qualifications:** + Applicants with specific ... experience in Medicare and / or Medicaid appeals are...the interdependencies between Medical Policy, Clinical Medical Review and Appeals and Grievances . + Ability to mentor… more
- Highmark Health (Charleston, WV)
- …them to assure ongoing relationships with the corporation maximize their effectiveness. + Grievances and Appeals - Assist in the evaluation and resolution of ... works closely with all divisions and departments within the corporate structure to provide clinical consultation and support with... grievances and appeals of patients, providers, and… more
- Molina Healthcare (Albuquerque, NM)
- …Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances , Member Appeals and Grievances , and other ... position plans, organizes, staffs, and coordinates the operations of state Medicaid/CHIP, Medicare and Marketplace Health Plan operations. * Works with staff and… more
- Commonwealth Care Alliance (Boston, MA)
- …or more core operational functions, including call centers, enrollment functions, and appeals / grievances . Knowledge, Skills & Abilities Required: + Knowledge of ... department and provides strategic direction and operational insight for CCA's Medicaid/ Medicare Dual Eligible enrollees and MAPD Plan members. + Oversee Member… more