- 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 End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours**...+ Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care… more
- AdventHealth (Altamonte Springs, FL)
- …drafting and submitting clinical denial appeals , as needed + Develops Medical Director relationships with payors to have open communication and consistently ... as a liaison between UM and CM teams and medical staff, as well as, the medical ...recommendations on appealed provider claims and makes determinations for appeals and grievances from patients; assists in… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... physical and mental well-being + Community engagement opportunities + And more! The Director of Quality, reporting to the AVP of Quality, is responsible for… more
- UPMC (Pittsburgh, PA)
- The Medical Director , Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... improvement review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals , and potential quality of care… more
- Trinity Health (Gaithersburg, MD)
- …The Director , Quality Improvement and Compliance, in collaboration with the Medical Director , is responsible for developing and implementing the annual QI ... will do:** + Develop and implement the annual Quality Improvement (QI) Plan with the Medical Director + In conjunction with Medical Director , initiates,… more
- Highmark Health (St. Paul, MN)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more
- State of Colorado (Denver, CO)
- …other DOC departments; + Responsible for budget, reporting, conflict resolution, inmate grievances , and maintaining a comprehensive inmate medical record; + ... 401K and 457 plans. Member Contribution Rates . + Medical and dental health plans; + Short and long...Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals… more
- State of Colorado (Pueblo, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes,… more
- State of Colorado (Pueblo, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... security/control functions, educational support services, daily programming, recreation, meals, medical referral and follow-up, and customer service. Responsible to… more
- State of Colorado (Golden, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... security/control functions, educational support services, daily programming, recreation, meals, medical referral and follow-up, and customer service. Responsible to… more
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