State Licensed Appeals Medical Director

Job Summary

A company is looking for an Appeals M.D. - PM&R required for a remote position.

Key Responsibilities

• Conduct individual case reviews for appeals and grievances related to various health plans and insurance products
• Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
• Collaborate with medical directors and staff regarding appeals decisions, network issues, and participate in organizational committees

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