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The UPMC Health Plan is seeking a board-certified physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC Community Health Choices. This role is fully remote and will require 10-18 hours per week between 8am - 4pm EST, in order to attend grievance hearings. One of the perks of this position is that the selected candidate will be able to choose their weekly availability within the aforementioned time frame. The Medical Director, Grievances is responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. They oversee adherence to quality and utilization standards through committee delegations and further establish an effective working relationship between the UPMC Health Plan's Network and its physicians, hospitals, and other providers. Responsibilities: • Provide leadership direction for provider credentialing processes., • Physicians must devote sufficient time to the CHC-MCO to provide timely medical decisions, including after-hours consultation, as needed, • Provide leadership and direction in meeting Quality Improvement and Care Management goals directed at improvements in member health status outcomes and established business strategies., • Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan., • Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns., • Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management., • Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality 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 Quality 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. Code 27.1 et seq., • Daily interventions support implementation of the Health Plan's Quality Improvement and Care Management Programs., • Represent the Health Plan in external accreditation and certification activities., • Act as first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments. 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)

RN charge nurses assuming responsibility for nursing and patient servicesin the absence of the Clinical Managermust have one-yearclinical experience and six months dialysis experience. Internal Contacts: Direct Patient Care Staff, Facility support staff, management teams (Clinical Manager, Area Mana

Social Worker Job Title: Social Worker Location: Camden County, NJ (based in Cherry Hill, NJ) Type: Direct Hire Contractor Work Model: Onsite Hours: Monday - Friday, 8:00 AM - 4:00 PM (35-hour work week, salaried position).May require flexing schedule to meet with case load as needed.Compensation: S

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company seeking talented and motivated individuals to join.This is NOT like other job posts you’ve responded to! Our team thrives on hard work,

Embark on an enriching nursing career at Redeemer Health, where you can select the clinical environment that matches your passion and skills. Whether it's our hospital, home care services, or senior care communities, you are recognized as a valued clinical expert. Utilizes advanced knowledge and cli

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company seeking talented and motivated individuals to join.This is NOT like other job posts you’ve responded to! Our team thrives on hard work,

We value your clinical knowledge and respect the deep one-on-one bond you establish with the families you care for. Of course, if you need anything, your Director of Nursing is only a phone call away we offer 24-hour, 365-day support and on-demand clinical resources. Taking direction from clinical

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company launching a new service and looking for individuals.You will earn $800 to $1,200 for ~20 hours with the opportunity for ongoing work.This

Of course, if you need anything, your Director of Nursing is only a phone call away we offer 24-hour, 365-day support and on-demand clinical resources. Taking direction from clinical team and being overseen by a registered nurse. Following all clinical and office policies.

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company seeking talented and motivated individuals to join.This is NOT like other job posts you’ve responded to! Our team thrives on hard work,

Taking direction from clinical team and being overseen by a registered nurse. Following all clinical and office policies. We value your clinical knowledge and respect the deep one-on-one bond you establish with the families you care for.

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company launching a new service and looking for individuals.You will earn $800 to $1,200 for ~20 hours with the opportunity for ongoing work.This

We value your clinical knowledge and respect the deep one-on-one bond you establish with the families you care for. Of course, if you need anything, your Director of Nursing is only a phone call away we offer 24-hour, 365-day support and on-demand clinical resources. Taking direction from clinical

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company launching a new service and looking for individuals.You will earn $800 to $1,200 for ~20 hours with the opportunity for ongoing work.This

We’re looking for enthusiastic, self-driven, individuals to assist existing and prospective clients within our organization.This position will work with multiple clients throughout the day providing outstanding service and product knowledge.Distributes all benefit enrollment materials and

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company launching a new service and looking for individuals.You will earn $800 to $1,200 for ~20 hours with the opportunity for ongoing work.This

This position requires strong clinical judgment and excellent communication skills.

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company launching a new service and looking for individuals.You will earn $800 to $1,200 for ~20 hours with the opportunity for ongoing work.This

Complete Care at Voorhees - (RN) Registered Nurse Supervisor - Lead with Compassion, Elevate Patient Care Are you a dedicated Registered Nurse looking to make a meaningful impact? As an RN Supervisor , you'll lead with compassion, elevate patient care, and support both residents and caregivers like

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company seeking talented and motivated individuals to join.This is NOT like other job posts you’ve responded to! Our team thrives on hard work,

Monitor clients' conditions; reporting changes to Clinical or Client Services Manager. A minimum of one year of recent, verifiable clinical (medical/surgical) experience.

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company seeking talented and motivated individuals to join.This is NOT like other job posts you’ve responded to! Our team thrives on hard work,

Complete Care at Bayshore, LLC - Part-time 3pm-11pm & 11-7 shift Registered Nurse Supervisor At Complete Care at Bayshore, we believe great care starts with a great team.Our residents aren't just patients—they're part of our extended family.That's why we're looking for an RN Supervisor who's ready

Candidates for this work-from-home position must be 21 or older, have an SSN, own a.Pennsylvania, Michigan and West Virginia.We are a gambling technology company launching a new service and looking for individuals.You will earn $800 to $1,200 for ~20 hours with the opportunity for ongoing work.This

This position requires strong clinical judgment and excellent communication skills.

Monitor clients' conditions; reporting changes to Clinical or Client Services Manager. A minimum of one year of recent, verifiable clinical (medical/surgical) experience.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Hospice/Palliative Medicine in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to

Our supportive environment includes: A comprehensive onboarding program Clinical educators, preceptors, and supervisors to mentor and guide Up to 90% off higher education (degrees, certifications) and test preparation for you and your family Dedicated schedulers to support flexible scheduling option

DocCafe has an immediate opening for the following position: Nurse Practitioner - Hospitalist in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ other

Core Medical Group is seeking a travel nurse RN Med Surg for a travel nursing job in Willingboro, New Jersey.Job Description & Requirements Specialty: Med Surg Discipline: RN Start Date: ASAP Duration: 13 weeks 36 hours per week Shift: 12 hours Employment Type: Travel Client in NJ seeking Registered

DocCafe has an immediate opening for the following position: Nurse Practitioner - Anesthesiology in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ oth

Ability to consistently deliver quality care in a busy clinical environment. Seeks out opportunities for additional clinical training and self-development in order to consistently provide quality care. Demonstrated working knowledge of clinical operations.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Internal Medicine in Abington, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ othe

Access to our Clinical Nurse Liaison Team.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Pulmonology in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ other

Monitor clients' conditions; reporting changes to Clinical or Client Services Manager. A minimum of one year of recent, verifiable clinical (medical/surgical) experience.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Urology in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ other open

Monitor clients' conditions; reporting changes to Clinical or Client Services Manager. A minimum of one year of recent, verifiable clinical (medical/surgical) experience.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Family Practice/Primary Care in New Jersey.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,000+ other

Genie Healthcare is seeking a travel nurse RN Med Surg for a travel nursing job in Willingboro, New Jersey.Job Description & Requirements Specialty: Med Surg Discipline: RN Start Date: ASAP Duration: 13 weeks 36 hours per week Shift: 12 hours, nights Employment Type: Travel Genie Healthcare is looki

DocCafe has an immediate opening for the following position: Nurse Practitioner - Psychiatric-Mental Health in Abington, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 120,0

Monitor clients' conditions; reporting changes to Clinical or Client Services Manager. A minimum of one year of recent, verifiable clinical (medical/surgical) experience.

DocCafe has an immediate opening for the following position: Nurse Practitioner - Physiatry/Physical Medicine & Rehabilitation in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job

What you’ll do: As a Jefferson Health at Home by BAYADA Nurse, you’ll use your clinical skills and compassionate heart to treat patients where they want to be the most – in the comfort of their own home. One year of clinical experience strongly preferred. Ability to perform 1:1 direct client c

DocCafe has an immediate opening for the following position: Nurse Practitioner - Family Practice/Primary Care in Philadelphia, Pennsylvania.Make $115,000 - $140,000/yearly.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to app

Social Worker Job Title: Social Worker Location: Camden County, NJ (based in Cherry Hill, NJ) Type: Direct Hire Contractor Work Model: Onsite Hours: Monday - Friday, 8:00 AM - 4:00 PM (35-hour work week, salaried position).May require flexing schedule to meet with case load as needed.Compensation: S

DocCafe has an immediate opening for the following position: Nurse Practitioner - Psychiatric-Mental Health in Philadelphia, Pennsylvania.DocCafe is the premier physician and advanced practice job board to help you advance your healthcare career.Register now to apply for this job and for access to 1

School Social Worker – Middle School (Bucks County, PA).Onward Search Education is a specialized education staffing and talent solutions firm that connects educators, therapists, and school health professionals with leading schools nationwide.We are currently partnering with a highly regarded dist