A company is looking for a Medical Director - Grievances and Appeals.Key ResponsibilitiesReview health claims and preservice appeals, providing medical interpretation and decisionsRepresent the organization at Administrative Law Judge hearingsExercise independent judgment on complex issues related to medical services complianceRequired QualificationsMD or DO degree with a current and unrestricted license in at least one jurisdictionBoard Certified in an approved ABMS Medical Specialty5 years of established clinical experienceKnowledge of the managed care industry, including Medicare, Medicaid, and / or Commercial productsPassion for improving consumer experiences within the organization
Advanced Heart Failure and Cardiac Transplant Medical Director
The Division of Cardiovascular Medicine at the University of Virginia School of Medicine seeks candidates for an Associate Professor or Professor, open track, as Medical Director of the Advanced Heart Failure and Cardiac Transplant group. The incumbent will be expected to provide clinical service in...
Associate Medical Director - Parkland Community Health Plan, PRN
Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine. Analyzes data to establish health care provider profiles and define acceptability of physician performance...
Grievances and Appeals Representative
A company is looking for a Grievances & Appeals Representative to manage client denials and concerns. ...
Associate Medical Director - Parkland Community Health Plan, PRN
Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine. Analyzes data to establish health care provider profiles and define acceptability of physician performance...
Reproductive Endocrinology and Infertility Physician - Fellowship Program Director
Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology and Infertility; and be eligible for Texas medical licensure and certification by the American Board of Obstetrics and Gynecology. The UT Southwestern Medical Center Department of Obstetrics and Gynecology seeks to fill a posit...
Associate Medical Director - Parkland Community Health Plan, PRN
Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine. Analyzes data to establish health care provider profiles and define acceptability of physician performance...
Human Resources Director
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving as...
Medical Director - Medicare Appeals
Direct daily work on part C appeals (both provider and member/nonparticipating providers) and Part D appeals. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health car...
Medical Director- Appeals
This Position Is Responsible For Assigned Aspects Of Medical Policies And Programs. Performs Medical Reviews And Interacts With The Provider Communities For Assigned Areas. Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Phys...
General Internal Medicine Physician & Associate Medical Director, Quality
As a member of the UT Southwestern Medical Group, you’ll have access to innovative technologies and be part of a multidisciplinary provider community comprised of more than 3,000 highly qualified, board-certified physicians, specialists, physician assistants, and nurse practitioners. Candidate must ...