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

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Search Results: 511 Jobs

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Case Manager RN in Behavioral Medicine- 780018

CHRISTUS Health

Alamogordo, New Mexico

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Senior Quality Improvement Leader

University of Maryland Medical System

Baltimore, Maryland

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Housekeeper

Vail Health

Vail, Colorado

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Materials Management Specialist - Westwood

UCLA

Los Angeles, California

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Security Officer (per diem) - Marina Del Rey

UCLA

Marina Del Rey, California

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Chief Executive Officer

ScionHealth

Lake Charles, Louisiana

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Housekeeper

Vail Health

Edwards, Colorado

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Security Officer - Security

Penn State Health

Camp Hill, Pennsylvania

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Anesthesiologist Assistant - Signing & Relo Bonus Provided (Full Time, Day shift)

Nicklaus Children’s Health System

Miami, Florida

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Allied Health Assistant Director

Vanderbilt Health

Nashville, Tennessee

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Practice Supervisor - Urology Outpatient Clinic

Foundation Health Partners

Fairbanks, Alaska

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Public Safety Officer (Full Time, Night shift)

Nicklaus Children’s Health System

Miami, Florida

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Radiology Front Desk

AdventHealth

Orlando, Florida

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Patient Transporter - Tyler

CHRISTUS Health

Tyler, Texas

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Financial Counselor

WMCHealth

Suffern, New York

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Environmental Services Tech

AdventHealth

Littleton, Colorado

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Director of Patient Accounts

WMCHealth

Valhalla, New York

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Chaplain, PRN

University of Maryland Medical System

Towson, Maryland

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Supervisor Clinic Operations

Baylor Scott & White Health

College Station, Texas

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Patient Transport Technician 2 - Ronald Reagan Medical Center

UCLA

Los Angeles, California

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Environmental Health Worker - Housekeeping

Penn State Health

Hershey, Pennsylvania

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Maintenance Mechanic II - 820005

CHRISTUS Health

Alamogordo, New Mexico

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Financial Counselor

WMCHealth

Suffern, New York

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Market Chief Executive Officer

Kindred Hospitals

Indianapolis, Indiana

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Security Officer - Santa Monica Hospital

UCLA

Santa Monica, California

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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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