Blue Cross of Idaho is seeking a strategic and operational leader to oversee the Grievance and Appeals department... in health insurance or healthcare operations, with at least 5 years in a leadership role overseeing grievance and appeals...
of the organization’s member and provider appeals, complaints, and grievance processes across all product lines, including..., and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process...
strategic oversight and operational management of the organization’s member and provider appeals, complaints, and grievance... adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution...
challenges. Primary Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical review... and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include...
. Growing together. Work at home! The Appeals and Grievances Medical Director is responsible for ongoing clinical review... and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. You'll enjoy the flexibility to work...
challenges. Primary Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical review... and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include...
for managing grievance and appeals on behalf of the plan to ensure operational and regulatory compliance. Maintains and ensures... integrity of case file and data collection systems and prepares data reports and analysis of grievance and appeals for program...
to Grievance & Appeals Case Analysts to ensure clinical solution followed on casework. Ensures casework complies with DHCS..., and/or as directed by management. * Serves as a clinical resource to the Grievance & Appeals team Identifies systematic or recurring...
and grievance cases to Medical Director (MD) for medical director oversight and necessity determination and communicate...Job Category: Customer Services and Operations Job Description: Your Role The Medicare and Medi-cal Appeals...
experience in a Managed Care environment 1 to 3 years' experience in grievance/appeals environment required The Ideal Person.... Discover more about us at www.amerihealthcaritas.com. Responsibilities: Reporting to the Supervisor, Appeals and Grievances...
experience in a Managed Care environment 1 to 3 years' experience in grievance/appeals environment required The Ideal Person.... Discover more about us at www.amerihealthcaritas.com. Responsibilities: Reporting to the Supervisor, Appeals and Grievances...
, in a consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases... by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas...
to Grievance & Appeals Case Analysts to ensure clinical solution followed on casework. Ensures casework complies with DHCS..., and/or as directed by management. * Serves as a clinical resource to the Grievance & Appeals team Identifies systematic or recurring...
and appeals, monthly medication inventory audit, and monitor any other quality indicators. This position will help lead the daily... operations of grievances and appeals process ensuring timely investigation and resolution in accordance with CMS, CDPH, and DMHC...
and appeals, monthly medication inventory audit, and monitor any other quality indicators. This position will help lead the daily... operations of grievances and appeals process ensuring timely investigation and resolution in accordance with CMS, CDPH, and DMHC...
Physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC Community Health Choices.... This role is fully remote and will require 18-20 hours per week between 8am - 4pm EST, in order to attend grievance hearings...
. Growing together. The Senior Director, Part C Appeals Role position is accountable for appeal & grievance analysis..., understanding root cause for appeal/grievance submissions and partnering across the enterprise to reduce appeals & grievances...
requested. Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Ensures...Anticipated End Date: 2025-10-31 Position Title: Medical Director - Radiation Oncology Job Description: Clinical...
for grievance and appeals appropriate for their specialty. Ensures consistent use of company medical policies when making medical...Anticipated End Date: 2025-10-10 Position Title: Medical Director - Medical Oncology Job Description: Clinical...
requested. Makes medical necessity determinations for grievance and appeals appropriate for their specialty. Ensures...Anticipated End Date: 2025-09-29 Position Title: Medical Director - Cardiology Job Description: Clinical...