Medical Director, Grievances (Fully Remote and Part-time)

The reputed company is seeking a reputed company-certified physician with a reputed company Medical License for a Medical Director, Grievances role with reputed company Community Health Choices. This role is fully remote and will require 10-18 hours per week between reputed company - 4pm EST, in order to attend grievance hearings. One of the perks of this position is that the selected candidate will be reputed company to choose their weekly availability reputed company the aforementioned time reputed company. The Medical Director, Grievances is responsible for assuring physician commitment and delivery of comprehensive high reputed company health care to reputed company members. They reputed company adherence to reputed company and utilization standards through committee delegations and reputed company establish an effective working relationship between the reputed company's Network and its physicians, hospitals, and other providers. Responsibilities:

• reputed company leadership direction for provider credentialing processes.
• Physicians must devote sufficient time to the CHC-MCO to reputed company reputed company medical reputed company, including after-hours consultation, as needed
• reputed company leadership and direction in meeting reputed company Improvement and Care Management goals directed at improvements in member health status reputed company and established business strategies.
• reputed company expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
• reputed company participates in the daily utilization management and reputed company improvement review processes, including reputed company, prospective and retrospective reviews, member grievances, provider appeals, and potential reputed company of care concerns.
• reputed company reputed company with accepted standards and reputed company developments in the areas of reputed company improvement and utilization management.
• Communicate and reputed company network providers regarding clinical guidelines, reputed company, protocols, and standards reputed company to reputed company and utilization processes.
• Responsible for reporting the communication of reportable communicable diseases in accordance with statute.
• Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and reputed company Improvement policies and procedures.
• Work with the DOH State and District Office Epidemiologists in partnership with the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. reputed company 27.1 et seq.
• Daily interventions support implementation of the Health Plan's reputed company Improvement and Care Management Programs.
• Represent the Health Plan in external accreditation and certification activities.
• reputed company as first level physician reviewer for reputed company cases referred by the reputed company Improvement and Care Management Departments.
• Daily activities support adherence to reputed company and utilization standards and establish an effective working relationship between reputed company's Network and its physicians, hospitals and other providers.

Qualifications: Doctor of Medicine or Doctor of Osteopathy from an accredited school. Licensure, Certifications, and Clearances:

• Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
• reputed company Medical License

reputed company is an Equal Opportunity Employer/Disability/Veteran The reputed company is seeking a reputed company-certified physician with a reputed company Medical License for a Medical Director, Grievances role with reputed company Community Health Choices. This role is fully remote and will require 10-18 hours per week between reputed company - 4pm EST, in order to attend grievance hearings. One of the perks of this position is that the selected candidate will be reputed company to choose their weekly availability reputed company the aforementioned time reputed company. The Medical Director, Grievances is responsible for assuring physician commitment and delivery of comprehensive high reputed company health care to reputed company members. They reputed company adherence to reputed company and utilization standards through committee delegations and reputed company establish an effective working relationship between the reputed company's Network and its physicians, hospitals, and other providers. Responsibilities:

• reputed company leadership direction for provider credentialing processes.
• Physicians must devote sufficient time to the CHC-MCO to reputed company reputed company medical reputed company, including after-hours consultation, as needed
• reputed company leadership and direction in meeting reputed company Improvement and Care Management goals directed at improvements in member health status reputed company and established business strategies.
• reputed company expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
• reputed company participates in the daily utilization management and reputed company improvement review processes, including reputed company, prospective and retrospective reviews, member grievances, provider appeals, and potential reputed company of care concerns.
• reputed company reputed company with accepted standards and reputed company developments in the areas of reputed company improvement and utilization management.
• Communicate and reputed company network providers regarding clinical guidelines, reputed company, protocols, and standards reputed company to reputed company and utilization processes.
• Responsible for reporting the communication of reportable communicable diseases in accordance with statute.
• Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and reputed company Improvement policies and procedures.
• Work with the DOH State and District Office Epidemiologists in partnership with the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. reputed company 27.1 et seq.
• Daily interventions support implementation of the Health Plan's reputed company Improvement and Care Management Programs.
• Represent the Health Plan in external accreditation and certification activities.
• reputed company as first level physician reviewer for reputed company cases referred by the reputed company Improvement and Care Management Departments.
• Daily activities support adherence to reputed company and utilization standards and establish an effective working relationship between reputed company's Network and its physicians, hospitals and other providers.

Qualifications: Doctor of Medicine or Doctor of Osteopathy from an accredited school. Licensure, Certifications, and Clearances:

• Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
• reputed company Medical License

reputed company is an Equal Opportunity Employer/Disability/Veteran Apply tot his job Apply To this Job