Medical Director - Grievances and Appeals

Job Summary

A company is looking for a Medical Director - Grievances and Appeals.

Key Responsibilities

• Review health claims and provide medical interpretation and decisions on service appropriateness
• Represent the organization at Administrative Law Judge hearings
• Exercise independent judgment on complex issues related to job duties

Required Qualifications

• MD or DO degree with a current and unrestricted license in at least one jurisdiction
• Board Certified in an approved ABMS Medical Specialty
• 5 years of established clinical experience
• Knowledge of the managed care industry, including Medicare and Medicaid
• Experience in quality management, utilization management, or similar fields