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Main Building Maintenance Inc. (MBM)

El Paso, Texas

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PIH Health

Downey, California

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Penn State Health

Hershey, Pennsylvania

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AdventHealth

Daytona Beach, Florida

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St. Luke's Health System

Ketchum, Idaho

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AdventHealth

Davenport, Florida

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Duke University Health System

Durham, North Carolina

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University of Maryland Medical System

Easton, Maryland

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AdventHealth

Ottawa, Kansas

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AdventHealth

Orlando, Florida

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AdventHealth

Ocala, Florida

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Duke University Health System

Durham, North Carolina

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Penn State Health

Hershey, Pennsylvania

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University of Maryland Medical System

Glen Burnie, Maryland

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PIH Health

Los Angeles, California

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Fred Hutchinson Cancer Center

Seattle, Washington

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AdventHealth

Ottawa, Kansas

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University of Maryland Medical System

Easton, Maryland

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PIH Health

Downey, California

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Kindred Hospitals

Denver, Colorado

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Penn State Health

Hershey, Pennsylvania

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Penn State Health

Hershey, Pennsylvania

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AdventHealth

Shawnee Mission, Kansas

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Medical Dr 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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