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

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Critical Care Cardiologist

UCHealth

Loveland, Colorado

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Pediatric Anesthesiologist

Baylor Scott & White Health

Temple, Texas

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Orthopedic Surgeon

UCHealth

Colorado Springs, Colorado

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Physician - Home Based Primary Care Medical Director (GEC)

Veterans Affairs, Veterans Health Administration

San Francisco, California, California

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Radiation Oncologist Opportunity

Trinity Health

Plymouth, Indiana

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Psychiatrist-Per Diem-Westchester Medical Center

WMCHealth

Valhalla, New York

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Physician - Hospice & Palliative Care Director

Veterans Affairs, Veterans Health Administration

Martinez, California, California

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Vascular Neurologist

ChristianaCare

Newark, Delaware

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Physician Executive - Chair, Department of Emergency Medicine and Service Line Leader

ChristianaCare

Newark, Delaware

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Neurology - Physician

Baylor Scott & White Health

Plano, Texas

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Advanced Imaging Cardiologist

UCHealth

Loveland, Colorado

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Pediatric Invasive and/or Non-Invasive Electrophysiologist - Nemours Children's Hospital, Delaware

Nemours

Wilmington, Delaware

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Registered Nurse RN - Northeast Georgia Physicians Group NGPG - Urgent Care - FT Days 12 hr shifts

Northeast Georgia Health System

Oakwood, Georgia

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Outpatient Neurologist

University of Maryland Medical System

Easton, Maryland

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Manager of Admissions

Kindred Hospitals

Philadelphia, Pennsylvania

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Part Time Nurse Practitioner - Home Based Medical Care - Baxley, GA

Optum

Baxley, Georgia

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Trauma, Critical Care and Acute Care Surgeon

Baylor Scott & White Health

Killeen, Texas

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Nephrology - Pediatric Nurse Practitioner

Phoenix Children's, Provider Recruitment

Phoenix, Arizona

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Util Mgmt (UM) Nurse RN

Harris Health System

Houston, Texas

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Trauma, Critical Care and Acute Care Surgeon

Baylor Scott & White Health

Belton, Texas

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Medical Director of Palliative Care and Hospice of Humboldt

Providence

Eureka, California

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Hospitalist Physician - College Station

Baylor Scott & White Health

College Station, Texas

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Case Management Coordinator

Kindred Hospitals

Gardena, California

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Pediatric Anesthesiologist

Baylor Scott & White Health

Killeen, Texas

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Gastroenterologist Opportunity at UM Charles Regional

University of Maryland Medical System

La Plata, Maryland

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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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