- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Corporate Medical Director provides medical interpretation and decisions about the ... factors and determining the best course of action. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness… more
- Dignity Health (Rancho Cordova, CA)
- …review of appealed cases, ensuring all relevant documentation is presented to the Medical Director . The nurse must meticulously track and document all appeal ... **Job Summary and Responsibilities** The Appeals and Grievances LVN is a...a critical role responsible for managing and resolving all medical necessity appeal requests from various stakeholders, including third-party… more
- Dignity Health (Bakersfield, CA)
- …support to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other ... offices, primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing… more
- Molina Healthcare (AZ)
- …actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...* Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for… more
- UCLA Health (Los Angeles, CA)
- …UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Medical Director , Clinical Operations to help shape the future of our ... plan. In this key leadership role, you'll work closely with the Medical Director , Department of Health Services and play a vital part in scaling Health Services… more
- Trinity Health (West Springfield, MA)
- …The Director , Quality Improvement and Compliance, in collaboration with the Medical Director , is responsible for developing and implementing the annual QI ... will do:** + Develop and implement the annual Quality Improvement (QI) Plan with the Medical Director + In conjunction with Medical Director , initiates,… more
- City of New York (New York, NY)
- …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy… more
- Highmark Health (Tallahassee, FL)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...* Identifying the need for Personal Representative Authorization form, Medical Record Release Authorization form, or Provider Payment Waiver… 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 (Canon City, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Officers" and are eligible for increased PERA benefits. + Medical and dental health plans; State of Colorado Benefits… more
- State of Colorado (Lakewood, CO)
- …employment laws, progressive discipline, records management, recruitment, responding to grievances , appeals , charges of discrimination, reorganization matters, ... a wide range of benefits to our employees. + Medical and dental options are available for permanent employees...knowledge of the action: Colorado State Personnel Board/State Personnel Director , Attn: Appeals Processing, 1525 Sherman Street,… more
- State of Colorado (Canon City, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... 401K and 457 plans. Member Contribution Rates . + Medical and dental health plans; + Short and long...and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance… more
- State of Colorado (Chaffee County, CO)
- …answers phone, order office and medical supplies, distribute and track medical grievances , arrange for repair of office equipment, monthly reporting, sort ... CDOC Medical Records Technician I - (BUENA VISTA) Print...Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to ... 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 (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, ... security/control functions, educational support services, daily programming, recreation, meals, medical referral and follow-up, and customer service. Responsible to… 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, ... security/control functions, educational support services, daily programming, recreation, meals, medical referral and follow-up, and customer service. Responsible to… more
- Cognizant (Salem, OR)
- …+ Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews +… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Officers" and are eligible for increased PERA benefits. + Medical and dental health plans. + Short and long...ensuring completion of mandatory annual training. + Resolving informal grievances This position may participate in the Duty Officer… more
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... The Labor Relations Manager provides support to the General Manager and Director of Human Resources on labor relations projects, priorities and issues. This… more
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