- Humana (Atlanta, GA)
- …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… more
- Centene Corporation (Atlanta, GA)
- …management programs, integrate physician services, quality assurance, appeals and grievances , and regulatory compliance programs with medical service and ... a fresh perspective on workplace flexibility. **Position Purpose:** The Medical Director works actively to implement and...resolution of member or provider grievances and appeals + Optimizes utilization of medical resources… more
- Highmark Health (Atlanta, GA)
- …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
- Elevance Health (Atlanta, GA)
- …of Medicare rules and regulations for program areas including but not limited to: claims, grievances and appeals , Part D and risk adjustment. + Knowledge of Risk ... objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and… more