Otolaryngology Medical Director

Job Summary

To oversee clinical review and adjudication of appeals and grievances cases, the remote Appeals and Grievances Medical Director specializing in Otolaryngology (ENT) will manage individual case reviews, communicate with medical directors regarding appeals, and participate in organizational committees.

Key responsibilities

• Perform individual case reviews for appeals and grievances across various health plan products
• Communicate with medical directors regarding appeal decision rationales and benefit interpretations
• Actively participate in team meetings focused on communication, feedback, and process improvement

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
• Familiarity with current medical issues and practices