- Humana (Madison, WI)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and… more
- CenterWell (Madison, WI)
- …compliance. Manages the Denials Management data analytics, denial and appeal process. The Director , Home Health Grievances & Appeals assists members, via phone ... caring community and help us put health first** The Director Denials Management provides leadership for the audit, appeal...required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to… more
- Molina Healthcare (Madison, WI)
- …under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy ... reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. *… more
- Humana (Madison, WI)
- …and build collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and ... in this role collaborates closely with Clinical Services and the Chief Medical Officer(CMO) to integrate the day-to-day administration and strategic management of… more
- CenterWell (Madison, WI)
- …a part of our caring community and help us put health first** A ** Director of Authorizations & Eligibility** is a senior revenue cycle leader responsible for the ... payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT,… more