California Licensed Appeals Medical Director
Job Summary
To support the clinical review and adjudication of appeals and grievances, the remote California Licensed Appeals Medical Director will manage individual case reviews for various health plan products, collaborate with medical directors on decision rationales, and participate in organizational committees focused on process improvement.
Key responsibilities
- Perform individual case reviews for appeals and grievances related to medical services and benefit coverage
- Communicate with medical directors regarding appeals decisions and network quality issues
- Actively participate in team meetings and provide clinical input for organizational projects and committees
Required qualifications
- MD or DO with an active, unrestricted license
- Board Certified in an ABMS or AOBMS specialty
- 5+ years of clinical practice experience
- 2+ years of Quality Management experience
- Familiarity with current medical issues and practices
Complete Job Description
The complete job description is available to members. Premium membership includes:
Full access to 41,964 remote jobs from human-vetted companies, updated daily
Resume Builder - AI-powered tool to craft, enhance, and tailor your resume to a specific job
Twice-monthly live group coaching and the full Remote Career Center
20% member discount on Career Services
Backed by a 30-day money-back guarantee
Company Company Name
Headquarters Headquarters
Founded Founded
Website
Wikipedia Wikipedia URL
BBB URL BBB URL
The company description is available to members. Go Premium for full access to every job and company profile in our remote jobs database, backed by a 30-day money-back guarantee.
