- CVS Health (Hartford, CT)
- …based (work at home) based anywhere in the US.** Responsibilities of this Medical Director role are related to Part C Medicare Appeals . This position is ... however the expectation is to cross train for regulated appeals . * Provide support to Medicare appeal...Specialty Preferred Qualifications * Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Sacramento, CA)
- … (CMD) relies on medical background to review 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 regarding the… more
- Humana (Honolulu, HI)
- …a part 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...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Possess analysis… 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
- 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
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- ... on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with… more
- Elevance Health (Tampa, FL)
- … medical guidelines, medical policy and requirements. + Prepares clinical grievances for medical director review. + Works with Medical Director on ... improvement interventions and audits. Responsible for more complex, sensitive and specialized medical necessity and administrative appeals cases such as NICU,… more
- Humana (Jefferson City, MO)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Senior CBO Appeals Analyst position requires an in-depth knowledge of healthcare pricing/reimbursement processes and procedures including ... collaboration with the Underpayment Team manager, the Senior CBO Appeals Analyst will work to further the CBO's goals...meetings. 6. Routinely meets with underpayment team manager and director to provide updates on KPI's. 7. Research and… more
- CVS Health (Tallahassee, FL)
- …our members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in designing, developing and deploying our ... reside in Florida and and must have a Florida medical license or be willing to obtain one. **Primary...not limited to UM case reviews, member and provider appeals *Participate in an on call schedule as needed… more