- NHS Management (Prattville, AL)
- …to the facility Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant. ... the Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation, and MDS/Clinical... Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as… more
- CVS Health (Hartford, CT)
- …in the US.** **Responsibilities of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals (both provider ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Centene Corporation (Jefferson City, MO)
- …with ensuring high quality medical director training to review Medicare UM and appeals , Clinical review quality oversight and management. + Utilization ... improvement activities. + Develop and have oversight of training and expertise for Medicare appeals reviews, ALJ hearings. Have oversight of STARS metrics… 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 ... Health - 1231 E Beltline Ave NE - Grand Rapids Department Name Grievance And Appeals Medicare - PH Managed Benefits Employment Type Full time Shift Day (United… more
- Humana (Lincoln, NE)
- …to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis ... 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
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** We are looking for a Director , Medical Review & Appeals for our Government Programs lines of business. The incumbent ... the overall Corporate Strategic Plan through direction and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality… 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
- CenterWell (Denver, CO)
- …compliance. Manages the Denials Management data analytics, denial and appeal process. The Director , Home Health Grievances & Appeals assists members, via phone ... and clinical policy development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills… 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 ... and determining the best course of action. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… 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
- Elevance Health (Tampa, FL)
- ** Medical Director - Florida Medicare ...the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... must reside in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida Medicare plans: Simply Healthcare… more
- Molina Healthcare (Augusta, GA)
- …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
- OhioHealth (Columbus, OH)
- …Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals . Working with OHA and CBSA facilities on wage index ... matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical… more
- Houston Methodist (Katy, TX)
- …medical coding, insurance billing, collections, patient account resolution, appeals /denials, customer service, cash applications, revenue integrity, etc. This ... or other applicable experience to the area assigned (eg, call center, medical billing, insurance collections) + Two years of supervisory or management experience.… more
- Humana (Juneau, AK)
- **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 (Raleigh, NC)
- **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 (Carson City, NV)
- **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
- Martin's Point Health Care (Portland, ME)
- …been certified as a "Great Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the utilization & ... drive short and long-range clinical programming, quality management, and external relationships. The Medical Director reports to the Vice President Health Plan … more
- Centene Corporation (Baton Rouge, LA)
- …a fresh perspective on workplace flexibility. **We're Hiring: Full-time Behavioral Health Medical Director ** Centene Corporation is a leading provider of ... and Neurology + 5+ years of post-residency experience **Position Purpose:** Assist the Sr Medical Director to direct and coordinate the medical management,… more
- Centene Corporation (Salem, OR)
- …including a fresh perspective on workplace flexibility. **We're Hiring: Full time Medical Director for Trillium Community Health Plan, our Oregon market. ... knowledge of quality accreditation standards highly preferred **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical … more
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