California Licensed Oncologist

Job Summary

To support clinical operations, the remote California Licensed Oncologist will manage the review and adjudication of appeals and grievances cases for various health plan products, ensuring compliance with regulatory standards.

Key responsibilities:

• Perform individual case reviews for appeals and grievances related to medical services and coverage determinations
• Communicate with medical directors regarding appeals decisions and benefit interpretations
• Participate in team meetings focused on process improvement, staff training, and sharing program results

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
• Intermediate proficiency with managed care