Remote Appeals Medical Director

Job Summary

Working remotely from anywhere in the U.S., the full-time salaried Appeals Medical Director will be responsible for the clinical review and adjudication of appeals and grievances cases for various health plan products, ensuring compliance with medical policies and regulatory standards.

Key responsibilities:

• Perform individual case reviews for appeals and grievances related to medical services and benefit coverage
• Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
• Communicate with medical directors and network management regarding appeals decisions and quality issues

Required qualifications:

• MD or DO with an active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics)
• 5+ years of clinical practice experience