California Licensed Oncologist

Job Summary

To support ongoing clinical review and adjudication of appeals and grievances, a California Licensed Oncologist will work remotely in a full-time capacity, managing individual case reviews for various health plan products and collaborating with medical directors on decision rationales.

Key responsibilities:

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

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