- UPMC (Pittsburgh, PA)
- …or Emergency Medicine Physician with a Pennsylvania Medical License for a Medical Director , Grievances role with UPMC Community Health Choices. This ... choose their weekly availability within the aforementioned time frame. The Medical Director , Grievances is responsible for assuring physician commitment and… more
- Humana (Topeka, KS)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. The Corporate … more
- Humana (Olympia, WA)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial. The Corporate … more
- Sanford Health (Sioux Falls, SD)
- …and grievances processing. Collaborate with legal, compliance, operations, and medical management teams to address complex cases and ensure proper resolution. ... appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal and state… more
- Molina Healthcare (Kenosha, WI)
- …* Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and resolving member complaints and ... 2 years in a manager role. * Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery,… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...This position will work with department Supervisors, Managers and Director for all problems related to quality improvements as… more
- AmeriHealth Caritas (Newark, DE)
- …for decision making or example, internal committee/panel, independent review organization, internal medical director - as process dictates + Provide support ... at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the administrative tasks… more
- University of Miami (Miami, FL)
- …The Director Risk Management will also oversee events involving patient grievances and complaints regarding patient care. The Director Risk Management of ... Risk Management, is responsible for the facilitation of Patient Grievances involving Quality of Care issues. The goal of...notification and documentation of potentially compensable events to Chief Medical Risk Officer, Director of Medical… more
- Sharp HealthCare (San Diego, CA)
- …the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for Sharp ... + 5 years' experience as an HMO Health Plan Medical Director . + California Physicians and Surgeons...and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends… more
- UPMC (Media, PA)
- …Behavioral Health (CCBH) is seeking a qualified individual to fulfill the role of Regional Medical Director in Delaware County, PA. The Regional Medical ... the provider network for the clinical needs of Community Care members. The Medical Director also participates in regional leadership policy decisions and… more
- Pine Acres Rehabilitation & Care Center (Nebraska City, NE)
- …Services Director will assist residents in voicing and obtaining resolution to grievances . The Director will review complaints and grievances made by ... SOCIAL SERVICES/ADMISSIONS DIRECTOR JOB DESCRIPTION Department Social Services Reports to...actions and interactions are adequately documented in each resident's medical record, and that legal, ethical, and professional standards… more
- University of Miami (Miami, FL)
- …Medicine, Cancer Survivorship has an exciting opportunity for an Assistant Professor of Clinical ( Medical Director ). The Medical Director is appointed by ... Sylvester Comprehensive Cancer Center for the respective discipline. The Medical Director shall be a member of...the respective discipline + Help to resolve complaints and grievances related to faculty physicians in the discipline +… more
- Sharp HealthCare (San Diego, CA)
- …as a physician executive in a managed care environment, preferably as an HMO Medical Director . + California Physicians and Surgeons License - Medical ... **Shift Start Time** **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours** **:** **Shift Start… more
- Munson Healthcare (Traverse City, MI)
- …CARE TEAM! Full-Time | Monday-Friday | No Call Munson Healthcare is seeking a Medical Director for Wound Care to oversee clinical operations, provide direct ... of medical services. In this position, the Medical Director is responsible for the oversight...company policies, review and respond to any complaints and grievances and recommend or take corrective action where appropriate,… more
- Molina Healthcare (Idaho City, ID)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care....experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Aperion Care (IL)
- …regulations that govern our facility, and as may be directed by the Administrator, the Medical Director , and/or the Director of Nursing, to ensure that the ... physician, the Director of Nursing, or the Medical Director of the facility, with an...in accordance with acceptable nursing standards. Report findings to Director . + Review complaints and grievances made… more
- CenterLight Health System (Flushing, NY)
- JOB PURPOSE: The Clinical Service Director , under the direction of the VP of Clinical Services, supervises all day-to-day operations of the Interdisciplinary teams ... and participant outcomes. As such, the CSD serves as the Director of Patient Services (DPS) for the LHCSA and coordinates the multi-disciplinary integrated care in… more
- UCLA Health (Los Angeles, CA)
- …UCLA Health Medicare Advantage Plan is looking for a dedicated and forward-thinking Associate Medical Director to help shape the future of our plan. In this ... key leadership role, you'll work closely with the UHMAP Medical Director and play a vital part in developing and guiding clinical policy that's grounded in the… more
- HCA Healthcare (Pembroke Pines, FL)
- …the implementation of policies and procedure that allows program complaints and grievances to receive due process and include evidence of resolution; implements ... strategies for continuous improvement based on the evaluation of complaints and grievances . e. Ensures that orientation to technology is provided and that… more
- UPMC (Pittsburgh, PA)
- The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director , Utilization Management role. The Medical Director , Utilization ... review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals, and potential quality of care concerns. +… more