Job Summary

A company is looking for a Medical Director for Medicare Appeals.

Key Responsibilities:

• Direct daily work on part C appeals and Part D appeals
• Provide support to appeal nurses and pharmacists, participate in Second Look Review process
• Develop expertise on Medicare policy, provide education to staff, and improve team efficiency

Required Qualifications:

• Two or more years of experience in a Health Care Delivery System
• Medical License (MD) or (DO) with an active state license
• Board Certified in ABMS Recognized Specialty
• Experience in Medical Management - Complaints, Grievance & Appeals preferred
• Health Plan Experience highly preferred