- Health Care Service Corporation (Richardson, TX)
- …development. **Job Summary** This Position Is Responsible For Assigned Aspects Of Medical Policies And Programs. Performs Medical Appeal Reviews And Interacts ... Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of… more
- Elevance Health (Grand Prairie, TX)
- **Clinical Operations Medical Director ** **Carelon Medical Benefit Management** **Radiation Oncology** **Virtual:** This role enables associates to work ... of clinical domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director ** is responsible for supporting the medical … more
- Molina Healthcare (Dallas, TX)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...* Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for… more
- Molina Healthcare (Dallas, TX)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance.… more
- Integrative Emergency Services (Dallas, TX)
- Integrative Emergency Services, LLC ("IES") is seeking a Director of Revenue Cycle - Specialty Services who will be responsible for the general supervision and ... cycle functions for physician practices supporting complex specialty service lines. The Director of Revenue Cycle Specialty Services is responsible for the strategic… more
- Texas Health Resources (Arlington, TX)
- …staff on care transition management principles. Escalates issues to Chief Quality Medical Officer (CQMO), Physician Advisor, and/or Senior Director as ... Director Care Transition _Are you looking for a...denials, avoidable days, alternate level of care days, etc. Medical necessity criteria, patient status, and discharge criteria. All… more