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Veterans Affairs, Veterans Health Administration Logo
Veterans Affairs, Veterans Health Administration

Togus, Maine, Maine

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Veterans Affairs, Veterans Health Administration

Astoria, Oregon, Oregon

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Veterans Affairs, Veterans Health Administration

Hinesville, Georgia, Georgia

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Veterans Affairs, Veterans Health Administration

Brockton, Massachusetts, Massachusetts

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Veterans Affairs, Veterans Health Administration

Montgomery, Alabama, Alabama

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Veterans Affairs, Veterans Health Administration

Stockton, California, California

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Veterans Affairs, Veterans Health Administration

Stockton, California, California

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Veterans Affairs, Veterans Health Administration

Anaconda, Montana, Montana

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Veterans Affairs, Veterans Health Administration

Palo Alto, California, California

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Veterans Affairs, Veterans Health Administration

West Palm Beach, Florida, Florida

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Veterans Affairs, Veterans Health Administration

Redding, California, California

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Veterans Affairs, Veterans Health Administration

Santa Rosa, California, California

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AdventHealth

Zephyrhills, Florida

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Veterans Affairs, Veterans Health Administration

Bronx, New York, New York

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Kindred Hospitals

Las Vegas, Nevada

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AdventHealth

Tampa, Florida

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AdventHealth

Orlando, Florida

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Veterans Affairs, Veterans Health Administration

Martinez, California, California

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AdventHealth

Tarpon Springs, Florida

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Kindred Hospitals

La Mirada, California

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Kindred Hospitals

La Mirada, California

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AdventHealth

Tarpon Springs, Florida

Natividad

Salinas, California

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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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