MD Appeals Director

Job Summary

A company is looking for an Appeals M.D. - Member Appeals to manage clinical reviews and adjudications of appeals and grievances cases.

Key Responsibilities

• Perform individual case reviews for appeals and grievances across various health plan products
• Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
• Collaborate with medical directors and management staff on access, availability, and quality issues

Required Qualifications

• MD or DO with an active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics)
• 5+ years of clinical practice experience