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Search Results: 161 Jobs
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Medica Logo
Clinical Pharmacist III - Clinic Partnerships
Medica

Minnetonka, Minnesota

Franklin Pharmaceutical Consulting, LLC Logo
Pharmaceutical Value Evidence and Medical Writing Consultant (HEOR, Medical, MA)
Franklin Pharmaceutical Consulting, LLC

Raleigh, North Carolina

Trinity Health of New England Logo
Associate Chief Medical Officer Opportunity in Hartford, CT
Trinity Health of New England

Hartford, Connecticut

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Northeast Georgia Health System Logo
Registered Nurse RN - Ortho - Neuro Surgical - PRN Nights - up to $52/hr
Northeast Georgia Health System

Gainesville, Georgia

NEW!
UCLA Logo
Physician Advisor
UCLA

Los Angeles, California

NEW!
UCLA Logo
Senior Cross-Functional Collections Representative
UCLA

Los Angeles, California

NEW!
UCLA Logo
Senior Cross Functional Collections Representative
UCLA

Los Angeles, California

NEW!
UCLA Logo
Application Manager - Beaker AP
UCLA

Los Angeles, California

NEW!
UCLA Logo
Senior Cross-Functional Collections Represenatative
UCLA

Los Angeles, California

NEW!
CHRISTUS Health Logo
Director Health Plans Corporate Services-HP Business Process Design
CHRISTUS Health

Irving, Texas

NEW!
UCLA Logo
Chief Medical Officer, Venice Family Clinic
UCLA

Venice, California

NEW!
Penn State Health Logo
Registered Nurse Care Manager - Peds Infusion Room
Penn State Health

Hershey, Pennsylvania

NEW!
CHRISTUS Health Logo
Registered Nurse Navigator Home Health Review-Health Admin
CHRISTUS Health

Irving, Texas

NEW!
Indiana University Health Logo
Registered Nurse - Cardiovascular Surgical Unit
Indiana University Health

Indianapolis, Indiana

NEW!
Sonic Healthcare USA Logo
Revenue Cycle Billing Manager
Sonic Healthcare USA

Hilo, Hawaii

NEW!
Northeast Georgia Health System Logo
Director-Executive Medical Staff and Verification Services
Northeast Georgia Health System

Gainesville, Georgia

NEW!
Pediatrix Medical Group Logo
AVP, Division Operations
Pediatrix Medical Group

Sunrise, FL, USA

NEW!
Geisinger Logo
RN - Registered Nurse Care Manager - Care Coordination
Geisinger

Scranton, Pennsylvania

NEW!
UCLA Logo
Payment Poster
UCLA

Los Angeles, California

NEW!
Northeast Georgia Health System Logo
Registered Nurse RN-IMC - FT Days Habersham
Northeast Georgia Health System

Demorest, Georgia

NEW!
University of Maryland Medical System Logo
Director, Practice Operations
University of Maryland Medical System

Towson, Maryland

NEW!
University of Minnesota Physicians Logo
Nurse Practitioner or Physician Assistant - Electrophysiology
University of Minnesota Physicians

Maplewood, Minnesota

NEW!
CHRISTUS Health Logo
Registration Representative / Full-time
CHRISTUS Health

Santa Fe, New Mexico

UCLA Logo
Administrative Assistant (On-Site)
UCLA

Los Angeles, California

UCLA Logo
Coach, Patient Access Organization (hybrid fixed)
UCLA

Irwindale, 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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