- The Planetary Society (San Francisco, CA)
- …solicit higher-level gifts for memberships and the Societys annual schedule of special appeals . In partnership with the Director of Community Giving, assist in ... Position Title: Director of Strategic Giving Status: Exempt, Full-Time Reports...for matching gift challenges to be used in mass appeals (typically in the $5,000$10,000 range). Contribute to strategies… more
- NHS Management (Prattville, AL)
- …Assists assigned facilities in accurately recording skilled services in the MDS and medical chart and providing rehab services at the highest practicable level for ... in the areas of general nursing, rehabilitation and restorative nursing, including medical practices in long term care Has a minimum two years experience… more
- Elevance Health (Norfolk, VA)
- **Behavioral Health Medical Director -Psychiatrist Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... - Friday. Half day Saturday rotation, once a month.** The **Behavioral Health Medical Director -Psychiatrist Appeals ** is responsible for the administration… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** We are looking for a Director , Medical Review & Appeals for our Government Programs lines of business. The incumbent ... Strategic Plan through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care complaints in… more
- CVS Health (Hartford, CT)
- …(work at home) based anywhere in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part ... * Board Certified in ABMS or AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Centene Corporation (Jefferson City, MO)
- …hearings, STARS metrics + Previous experience with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality ... plan leaders and cross functional stakeholders across the enterprise. + Provide medical leadership for all utilization management ( appeals ), pharmacy, case… more
- Centene Corporation (Austin, TX)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical ... implementation of performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals and policies… more
- Health Care Service Corporation (Albuquerque, NM)
- …development. **Job Summary** This Position Is Responsible For Assigned Aspects Of Medical Policies And Programs. Performs Medical Appeal Reviews And Interacts ... Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of… more
- Humana (Lincoln, NE)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director ...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- Centene Corporation (Jefferson City, MO)
- …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
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Corporate Medical Director provides medical interpretation and decisions about the ... factors and determining the best course of action. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director , Pre Appeals ... and coordination of care to improve patient outcomes while controlling costs. The Director collaborates closely with medical staff, vendors, case management, and… more
- CVS Health (Baton Rouge, LA)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the management of ... as guiding other internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also responsible for working with the Presidential… more
- CenterWell (Denver, CO)
- …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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …reporting variances in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/ Medical Director in the appeals ... necessity for the requested level of care/patient status to the Medical Director . + Proactively identifies and resolves delays and obstacles for safe discharge.… more
- BronxCare Health System (Bronx, NY)
- Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
- Elevance Health (Indianapolis, IN)
- …records of denied services for medical necessity. + Extrapolates and summarizes medical information for medical director , consultants and other external ... Appeals ** is responsible for investigating and processing and medical necessity appeals requests from members and...or overturn (approve) requested appealed service and forwards to Medical Director for final review and decision.… more
- BronxCare Health System (Bronx, NY)
- …the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to ... identification of patterns and trends identified during the course of appeals preparation. Conduct departmental performance improvement audits, analyze findings and… more
- Corewell Health (Grand Rapids, MI)
- …+ Act as lead for expedited requests, gathering relevant information, working with Medical Director to determine if criteria is met. If expedited criteria ... This position will support our non-contracted provider post claim appeals submitted to the health plan. Job Summary Responsible for the analysis, research and… more
- Elevance Health (Indianapolis, IN)
- …for member grievance concerns and Quality of Care cases. + Extrapolates and summarizes medical information for medical director + Prepares nurse summaries ... Appeals ** is responsible for investigating and processing and medical necessity appeals requests from members and...for Quality of Care cases and forwards to Medical Director for review and determination. +… more
