Remote Appeals Medical Director

Job Summary

Working remotely, the full-time salaried Appeals Medical Director in Internal Medicine will manage the clinical review and adjudication of appeals and grievances cases for various health plan and insurance products.

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 regarding appeals decisions and participate in team meetings focused on 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
• Intermediate proficiency with managed care