MD Appeals Medical Director

Job Summary

Working remotely, the part-time Appeals MD Medical Director will manage clinical reviews and adjudications of appeals and grievances for various health plan products, ensuring compliance with medical policies and regulatory requirements.

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 and organizational committees to provide clinical and strategic input

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 and basic computer skills