Medical Director Appeals Reconsiderations

Job Summary

A company is looking for an Appeals and Grievances Medical Director Reconsiderations.

Key Responsibilities

• Conduct clinical review and adjudication of appeals and grievances for various health plan products
• Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
• Collaborate with medical directors and 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 Pediatricians)
• 5+ years of clinical practice experience
• 2+ years of Quality Management experience
• Intermediate proficiency in managed care