- 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
- Dignity Health (Bakersfield, CA)
- …support to the Medical Director of Utilization Management in medical review activities, peer-to-peer consultations, appeals and grievances and other ... offices primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing… more
- State of Colorado (Grand Junction, CO)
- …Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director 's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, ... Behavioral Site Director (Health Professional V) - Grand Junction Regional...to themselves or others to people who have significant medical challenges. Programs are individualized to meet varying needs.… more
- Molina Healthcare (Detroit, MI)
- …actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...* Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for… 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 ... improvement review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals , and potential quality of care… more
- Guardian Life (Plano, TX)
- …compliant with applicable state regulations. You will ensure that claims, referrals, appeals , and grievances meet state specific regulations, timeframes, and ... The **Dental Director ** will be responsible for ensuring that professional...& ensure that determination and processing of claims, referralsand appeals meet state regulations, time frames& definitions. + Completeadjudication… 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
- Independent Health (Buffalo, NY)
- …for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing health ... Medical Director . This position will prepare written responses to appeals and complaints/ grievances , establish plans of correction and provide education… more
- AmeriHealth Caritas (Washington, DC)
- …Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances , Member Appeals and Grievances , Network adequacy and ... **Job Responsibilities** The Director Operations (Healthy DC Plan) reports to the...and will also receive our benefits package, consisting of medical , vision, dental, life insurance, disability insurance, 401(k), paid… more
- City of New York (New York, NY)
- …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... planning, payroll management, compliance, labor relations, and policy implementation. The Director of Labor and Employee Relations will report to the Deputy… more