- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on ... AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly… more
- Humana (Washington, DC)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Raleigh, NC)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on… more
- Humana (Carson City, NV)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement...and care received. May also engage in disputes and grievance and appeals reviews. May participate on… more
- City of New York (New York, NY)
- …planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy ... arise with CFB employees. - Serve as the CFB's grievance representative and administer the contractual grievance ...process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the Office… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- CVS Health (Tallahassee, FL)
- …needed and state calls. Understand UM and participate in UM front line work and appeals in markets as needed. * Confer directly with providers regarding the care of ... through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical coverage review, member… more
- Elevance Health (Miami, FL)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Medical Director ** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual**...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
- Sioux City Community School District (Sioux City, IA)
- Job Details Job ID: 5460842 Job Description EXECUTIVE SUMMARY The Executive Director supports the mission of the Sioux City Community School District by fostering ... and develop communication for donor stewardship including thank you letters, appeals , newsletters, social media, impact reports, and other communications. + Plan… more
- Elevance Health (Woodbridge, NJ)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Medical Director ** **Carelon Medical Benefit Management** **Radiation Oncology** **Virtual:** This role enables associates to work virtually… more
- Elevance Health (New York, NY)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... **Clinical Operations Medical Director ** **Carelon MBM** **Virtual:** This role enables associates to work virtually full-time, with the exception of required… more
- UCLA Health (Los Angeles, CA)
- …perspective balanced with a strategic, data-informed approach + Deep understanding of grievance and appeals processes, with the ability to identify systemic ... Description The Assistant Director , Member Experience will work closely with the Director of Medicare Product Development & Bids to develop, lead, and execute… more
- Transdev (Dorchester, MA)
- …The Labor Relations Manager provides support to the General Manager and Director of Human Resources on labor relations projects, priorities and issues. This ... + Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and… more
- LA Care Health Plan (Los Angeles, CA)
- …all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters ... required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by… more
- State of Colorado (Brighton, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... and respond to youth grievances in accordance with DYS Policy 13.2 Grievance Procedures. Responsible for logging grievances on the tracking form and submitting… more
- Johns Hopkins University (Baltimore, MD)
- …Office of Employee and Labor Relations. This position will report, to the Director of Employee Relations and Labor Relations (ER/LR). This position will provide a ... actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer,… more
- State of Colorado (CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative… more
- University of Colorado (Aurora, CO)
- …chairs, human resources, and university leadership. + Address faculty concerns regarding grievance procedures, and appeals processes and serve as a neutral ... + Oversee compliance with annual performance reviews, post-tenure reviews, and grievance processes. + Interpret and apply faculty policies (eg, faculty leaves… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …the Louisiana House of Representatives and reports directly to the Human Resources Director . This role is responsible for creating and leading the House HR Training ... procedures, including review of documentation such as I-9 forms, grievance reports, workers' compensation claims, and pre-existing condition disclosures. The… more