- CVS Health (Salem, OR)
- …in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both provider and ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Columbus, OH)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- CVS Health (Columbus, OH)
- …have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical ... and consistent responses to members and providers. As a Medical Director you will focus primarily on...will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals … more
- VNS Health (Manhattan, NY)
- …individual grievances and appeals . Consults with enrollees, providers and the Medical Director , as appropriate. + Provides input and recommendations for ... state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care,… more
- VNS Health (Manhattan, NY)
- …staff at all levels including but not limited to, Provider Relations, Claims, Medical Director , third party administrator, pharmacy benefit manager, to achieve ... appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health product lines. *...minimum of three years' experience in a Grievance and Appeals or related area such as medical … more
- LA Care Health Plan (Los Angeles, CA)
- …the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director . This position provides assistance to members with health care ... authorization evaluation. Investigate Provider Disputes/PDR and prepares clinical summary for Medical Director determination. Work with the external providers… more
- LA Care Health Plan (Los Angeles, CA)
- … medical necessity reviews. Prepares authorizations, after approval by the Medical Director . When necessary, outreaches to providers, vendors, hospitals, and ... Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job...in a manner consistent with LA Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit… more
- HCA Healthcare (Nashville, TN)
- **Description** **Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient and effective ... and delivery of all coding operations education components and an effective coding appeals review process for the HCA Physician Services Group (PSG). The education… more
- UCLA Health (Los Angeles, CA)
- …and that clear, timely communication is provided to all stakeholders + Working closely with medical director and appeal & grievance team to ensure that all cases ... 2 or more years of experience in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred *… more
- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Elevance Health (Atlanta, GA)
- ** Medicare Medical Director ** Location:...the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... 50 miles of one of our Elevance Health PulsePoint locations. The ** Medicare Medical Director ** is responsible for the administration of physical and/or… more
- Elderwood (Buffalo, NY)
- …us support our commitment to providing exceptional care to our residents. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Responsible for ... any denials and assist in follow up of timely appeals process. + Conduct weekly aging reviews to address...Insurance, Medical , Dental, and Vision insurance Responsibilities Medical Billing Specialist ( Medicare /Managed Care): + Review… more
- Point32Health (Canton, MA)
- …are approved by senior leadership, the Senior Manager, in collaboration with the Director , is responsible for all necessary product filings with CMS and other ... business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future.… more
- CVS Health (Sacramento, CA)
- …assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs and ... Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs....medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental ( Medicare /Medicaid) programs… more
- Elevance Health (Atlanta, GA)
- …objectives. + Collaborates with management to set strategic vision; oversees manager(s)/ director (s) with direct reports. + Hires, trains, coaches, counsels, and ... Skills, Capabilities and Experiences** + Knowledge and understanding of Medicare rules and regulations for program areas including but...areas including but not limited to: claims, grievances and appeals , Part D and risk adjustment. + Knowledge of… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and ...to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all… more
- Centene Corporation (Sacramento, CA)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervisory Medical Director at Centene plays a critical role in ... to our members. This role further assists the Senior Medical Director or Chief Medical ...care quality + Oversee and actively participate in the appeals process, ensuring that appeals are handled… more
- Lancaster General Health (Lancaster, PA)
- **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director , Hospitalist Services is responsible for assisting the Medical ... The Associate director will report to LGHP Medical Director and have a reporting relationship...their satisfaction with LRH's services + Provide assistance with appeals of claims denied by government and other third-party… more
- State of Colorado (Denver, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Director of Psychology - *License Required - Colorado...over six treatment milieus serving civil and forensic individuals. Medical services, occupational therapy, neuropsychological-rehabilitation services, and trauma-informed care… more