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California Correctional Health Care Services

Corcoran, California

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AdventHealth

Altamonte Springs, Florida

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University of Maryland Medical System

Baltimore, Maryland

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AdventHealth

Tampa, Florida

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AdventHealth

Orlando, Florida

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AdventHealth

Parker, Colorado

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Davenport, Florida

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AdventHealth

Orlando, Florida

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AdventHealth

Orlando, Florida

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Sutter West Bay Medical Group

San Francisco, California

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Littleton, Colorado

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Maitland, Florida

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AdventHealth

Littleton, Colorado

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AdventHealth

Altamonte Springs, Florida

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AdventHealth

Altamonte Springs, Florida

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AdventHealth

Shawnee Mission, Kansas

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Vanderbilt Health

Nashville, Tennessee

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AdventHealth

Orlando, Florida

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AdventHealth

Altamonte Springs, Florida

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Enterprise Medical Recruiting

Morgantown, West Virginia

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Northwest Permanente, Kaiser Permanente Northwest

Portland, Oregon

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Duke University Health System

Durham, North Carolina

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Medical Dr 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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