Medical Director of Appeals and Grievances

5 days ago


Houston, Texas, United States Harris Health System, Inc. Full time
About the Role

As a Medical Director of Appeals and Grievances at Harris Health System, Inc., you will play a critical role in ensuring that our Members receive high-quality healthcare services. Your expertise will be instrumental in resolving complex appeals and grievances, upholding the highest standards of patient care and satisfaction.

Key Responsibilities
  • Lead the appeals and grievances process, ensuring timely and fair resolutions
  • Collaborate with healthcare providers, Members, and internal stakeholders to resolve disputes
  • Develop and implement policies and procedures to improve the appeals and grievances process
  • Stay up-to-date with regulatory requirements and industry best practices
  • Provide education and training to healthcare providers on appeals and grievances processes
Requirements

To be successful in this role, you will need:

  • Strong clinical expertise and knowledge of healthcare regulations
  • Excellent communication and interpersonal skills
  • Ability to analyze complex situations and make sound decisions
  • Strong leadership and problem-solving skills
  • Experience in appeals and grievances management, preferably in a healthcare setting
What We Offer

Harris Health System, Inc. offers a dynamic and supportive work environment, with opportunities for professional growth and development. As a Medical Director of Appeals and Grievances, you will have the chance to make a meaningful impact on the lives of our Members and contribute to the success of our organization.



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