- Humana (Frankfort, KY)
- …caring community and help us put health first** The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services ... determining the best course of action. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness...protect member PHI / HIPAA information This is a remote position \#LI- Remote Travel: While this is… more
- Dignity Health (Bakersfield, CA)
- … of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other related duties. **Job Requirements** ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- Cognizant (Salem, OR)
- …or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews + ... **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work… more
- State of Colorado (Pueblo, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... This position ensures compliance with nondiscrimination policies and manages grievances related to discrimination. This position manages complaints, develops… more
- State of Colorado (Golden, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... professional development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in… more
- State of Colorado (Greeley, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... ongoing professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …(CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, ... subscriber certificates and apply to the investigation of member grievances . + Manage the fair hearing process for cases...to the hearing panel. + Seek CPRC Chair, CPR Director , and BCBSMA Legal Counsel approval on appropriate language… more
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