- 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
- VNS Health (Manhattan, NY)
- OverviewManages the day to day activities for staff handling of grievances and appeals for one of the following VNS Health Plans product lines - Managed Long ... Term Care (MLTC), Medicare Advantage (MA) or Select Health. Ensures compliance with...management of clinical appeals review processes within Appeals & Grievances Department. + Manages the… 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
- 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