- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- VNS Health (Manhattan, NY)
- …exciting opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), ... high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. *...Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Part D, or Select Health to… more
- CareFirst (Baltimore, MD)
- …(RN) is to evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs (Maryland Medicare and Medicaid). ... training and/or other business-related activities. **ESSENTIAL FUNCTIONS:** + Reviews Clinical Appeals and Grievances documentation written by the clinical … more
- Elevance Health (Columbus, OH)
- …management consultant. + Domain expertise with health plan operations and back office, Medicare , Medicaid, Grievances & Appeals (G&A), Enrollment, and ... in partnership with blue cross blue shield plans. Our Government Health Benefits Grievances and Appeals , Enrollment, and Billing Organization is looking to hire… more
- Molina Healthcare (Richmond, VA)
- …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
- Molina Healthcare (Phoenix, AZ)
- …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
- BlueCross BlueShield of North Carolina (NC)
- …healthcare services provided to Plan members + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care + ... pharmacy utilization and effective resource management + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements + Reviews quality… more
- Fallon Health (Worcester, MA)
- …as quality improvement, credentialing, member rights, utilization management, including member appeals and grievances to support them in accreditation ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more