California Licensed Pulmonologist
Job Summary
To support the adjudication of appeals and grievances, the remote California Licensed Pulmonologist will manage clinical reviews for various health plan products, communicate with medical directors, and participate in quality management initiatives.
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 benefit interpretations
- Participate in team meetings focused on process improvement, 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
- Familiarity with current medical issues and managed care practices
Complete Job Description
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