- Humana (Charleston, WV)
- …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 ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** This role actively manages all Medicare reconsiderations, grievances , and appeals , adhering to company policies and CMS regulatory ... Corporate and CMS regulatory standards. **Job Title: Appeals & Grievances Coordinator** **Location: Pearland Administrative...Care experience in a managed care environment working with appeals and grievances . Preferred: Medicare … more
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently...such as Microsoft Word and Excel, as well as corporate email and virtual filing system, (ie. Macess). Experience… more
- VNS Health (Manhattan, NY)
- …exciting opportunity to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), ... high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. *...Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Part D, or Select Health to… more
- CareOregon (Portland, OR)
- …of subcontracted entities, fraud waste and abuse prevention planning and investigations, grievances , hearings and appeals , corporate risk assessment and ... tracking, documentation, collection, file maintenance, reporting and resolution of the hearings, appeals and grievances processes. + Develop and lead Health… more