California Licensed Plastic Surgeon

Job Summary

To support the clinical review and adjudication of appeals and grievances, a California Licensed Plastic Surgeon will work remotely in a full-time capacity, focusing on case reviews for various health plans and collaborating with medical directors on decision rationales and quality issues.

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 to enhance communication, feedback, and process improvements

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