• Medicare Grievances and Appeals

    Humana (Phoenix, AZ)
    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
    Humana (10/29/24)
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  • Medical Director - Medicare

    Molina Healthcare (Phoenix, AZ)
    …actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees ... + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
    Molina Healthcare (11/02/24)
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  • Medical Director

    Highmark Health (Phoenix, AZ)
    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
    Highmark Health (10/23/24)
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  • Dental Director

    CVS Health (Phoenix, AZ)
    …care more personal, convenient and affordable. **Job Purpose and Summary:** The Dental Director - Medicare Appeals is an individual contributor who will assure ... Quality Management processes, including credentialing, site assessments, peer review, complaints, grievances and appeals (CGA) + Consults and lends expertise… more
    CVS Health (11/08/24)
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