- CVS Health (Salem, OR)
- …in the US.** Responsibilities of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C appeals (both provider and ... policy for the enterprise * Provide ongoing education regarding Medicare policy and appeals to the appeal...Recognized Specialty **Preferred Qualifications** Medical Management - Medicare Complaints, Grievance & Appeals experience. *… more
- Humana (Harrisburg, PA)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation...experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be… more
- Humana (Concord, NH)
- …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
- 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- …the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director . This position provides assistance to members with health care ... authorization evaluation. Investigate Provider Disputes/PDR and prepares clinical summary for Medical Director determination. Work with the external providers… more
- UCLA Health (Los Angeles, CA)
- …and that clear, timely communication is provided to all stakeholders + Working closely with medical director and appeal & grievance team to ensure that all cases ... 2 or more years of experience in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred *… more
- Molina Healthcare (Long Beach, CA)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical ...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Elderwood (Buffalo, NY)
- …us support our commitment to providing exceptional care to our residents. Medical Billing Specialist ( Medicare /Managed Care) Position Overview: + Responsible for ... any denials and assist in follow up of timely appeals process. + Conduct weekly aging reviews to address...Insurance, Medical , Dental, and Vision insurance Responsibilities Medical Billing Specialist ( Medicare /Managed Care): + Review… more