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Trinity Health

Albany, New York

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SSM Health

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Trinity Health

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Trinity Health

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Trinity Health

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Trinity Health

Osage, Iowa

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Trinity Health

Albany, New York

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Duke University Health System

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Reading, Pennsylvania

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Troy, New York

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Albany - Troy, New York

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Riverside, California

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Trinity Health

Albany, New York

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Trinity Health

Saratoga Springs, New York

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Schenectady, New York

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CommonSpirit Health Mountain Region

Garden City, Kansas

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Trinity Health

Schenectady, New York

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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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