We interpreted Centerville, OH as Centerville, OH. Other options include: Centerville (Gallia County), OH
- Elevance Health (Mason, OH)
- ** Appeals Medical Director - Medicare ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director ** is responsible for the appeal reviews for physical… more
- Elevance Health (Mason, OH)
- …recommendations to either uphold or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely ... for medical necessity. + Extrapolates and summarizes medical information for medical director ,...appeals experience. + Leadership or management experience. + Medicare experience. For candidates working in person or virtually… more
- Molina Healthcare (Dayton, OH)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... 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
- Molina Healthcare (Dayton, OH)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance.… more