Job Seekers, Welcome to NQF Quality Careers
Search Filters
Use this area to filter your search results. Each filter option allows for multiple selections.
NEW! NEW!
NEW! NEW!
NEW! NEW!
NEW! NEW!
Atlantic Health System
Newton, New Jersey
NEW! NEW!
NEW! NEW!
Northwell Health
Staten Island, New York
NEW! NEW!
NEW! NEW!
University of Maryland Medical System
Linthicum Heights, Maryland
NEW! NEW!
NEW! NEW!
UCLA
Los Angeles, California
NEW! NEW!
NEW! NEW!
NEW! NEW!
NEW! NEW!
NEW! NEW!
Vanderbilt Health
Nashville, Tennessee
NEW! NEW!
University of Maryland Medical System
Baltimore, Maryland
NEW! NEW!
NEW! NEW!
NEW! NEW!
NEW! NEW!
Clinton Memorial Hospital
Wilmington, Ohio
NEW! NEW!
NEW! NEW!
NEW! NEW!
NEW! NEW!
NEW! NEW!
Loading... Please wait.
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.
Loading. Please wait.