- Humana (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Director , Grievances & Appeals manages the client medical denials experience ... in a timely manner to provide resolutions for Humana membership. The Director , Grievances & Appeals requires an in-depth understanding of how organization… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate Medical ... Director works on problems of diverse scope and complexity...complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness… more
- Gwinnett County Public Schools (Suwanee, GA)
- …of Employee Relations will assist in providing resolution in matters related to grievances and appeals , training and development to administrators and employees ... Director of Employee Relations - Office of Employee...on equity, compliance, accommodation, grievances , and Title IX.1. Leads equal opportunity and other… more
- Molina Healthcare (Atlanta, GA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Highmark Health (Atlanta, GA)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with… more