Medical Director Appeals Grievances in Houston, TX for Harris Health System

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Ultrasound Technologist II (Sonographer) (Outpatient)-Lee's Hill Emergency Department-Full Time Days

Mary Washington Healthcare

Fredericksburg, Virginia

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Medical Technologist/Medical Lab Technician (Micro), FT, Evening

Mary Washington Healthcare

Fredericksburg, Virginia

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St. Louis Outpatient Family Medicine Practice | 4 Day Week | 330K+ Potential|JO-2402-9622

Jackson Physician Search

Illinois

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Licensed Mental Health Therapist (LCSW, LICSW, LMHC, LMFT)

LifeStance Health

Lexington, MA

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Interventional Cardiology - Central Illinois

Carle Health

Normal, Illinois

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Medical Laboratory Scientist (MLS) or MLT, PT, Weekends Only, Varied Shifts, Core Lab

Mary Washington Healthcare

Fredericksburg, Virginia

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Manager Ambulatory Practice Family and Internal Medicine

Yuma Regional Medical Center

Yuma, Arizona

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Lead Administrative Assistant - Comprehensive Care Clinic

Vanderbilt Health

Nashville, Tennessee

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Radiologist - Los Angeles

Southern California Permanente Medical Group

Los Angeles, California

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Hospitalist

Swedish

Seattle, Washington

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Medical Technologist, Sr (Full-time) - Kapiolani Medical Center, HI

Sonic Healthcare USA

Honolulu, Hawaii

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Licensed Mental Health Therapist (LMFT, LCSW, LPCC)

LifeStance Health

Sacramento, CA

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Licensed Mental Health Therapist (LCSW, LICSW, LMHC, LMFT)

LifeStance Health

Brookline, MA

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Lead Clinical Supply Specialist

Vanderbilt Health

Nashville, Tennessee

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Anesthesiologist - Orange County

Southern California Permanente Medical Group

Anaheim, California

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Colorectal Surgeon

Providence

Missoula, Montana

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IDS Call Center Ancillary Lead, FT Days

PIH Health

Whittier, California

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Expanding Vascular Surgery Group Opening with Top Regional Employer in PA|JO-2405-10434

Jackson Physician Search

Pennsylvania

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Registered Nurse (RN), New Grad, M/S

University of Maryland Medical System

Glen Burnie, Maryland

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Director, Human Resources

University of Maryland Medical System

La Plata, Maryland

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Chair of Cardiology – Northern Westchester Hospital and Phelps Hospital, Northwell Health

Northwell Health

Mt Kisco, New York

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ScionHealth

Broken Arrow, Oklahoma

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ICU RN FT

ScionHealth

Austin, Texas

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Ophthalmology (Glaucoma) Assistant Professor, Non Tenure Track

University of Minnesota Physicians

Minneapolis, Minnesota

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CT Technologist (Computed Tomography) (Inpatient)-Full Time Days/Evenings

Mary Washington Healthcare

Fredericksburg, Virginia

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Medical Director Appeals Grievances

JOB SUMMARYThe Medical Director, Appeals and Grievances provides leadership for Community Health Choice medical management programs. This includes reviewing appeals of adverse determinations, tracking them and providing feedback to Medical Affairs on current overturn trends. In addition will provide clinical input and oversight for Care (Disease) Management, Quality Improvement, Credentialing, and Preventive Health programs. Will work with Provider Relations to maintain and improve relationships with the provider community especially with Value based arrangements. Will perform medical necessity reviews as assigned including reviews with peer-to- peer interactions as needed and other duties as assigned.

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