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UF Health Shands Hospital - Gainesville

Gainesville, Florida

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UF Health Shands Hospital - Gainesville

Gainesville, Florida

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Vail Health

Vail, Colorado

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Kindred Hospitals

Santa Ana, California

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Edwards, Colorado

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Vail Health

Vail, Colorado

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Vail, Colorado

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Camp Hill, Pennsylvania

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Memorial Sloan Kettering Cancer Center

New York, New York

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Vail Health

Vail, Colorado

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Bossier City, Louisiana

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Suffern, New York

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Chicago, Illinois

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Shreveport, Louisiana

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Nicklaus Children’s Health System

Miami, Florida

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Wilmington, Delaware

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Corpus Christi, Texas

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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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