State Licensed Appeals Medical Director
Job Summary
To support ongoing clinical review and adjudication of appeals and grievances cases, the remote State Licensed Appeals Medical Director will manage individual case reviews for various health plan products, communicate with medical directors and network management staff, and provide clinical input on organizational projects.
Key responsibilities:
- Perform individual case reviews for appeals and grievances related to medical services and coverage determinations
- Communicate with medical directors regarding appeals decisions and benefit interpretations
- Participate in team meetings to enhance communication, problem-solving, 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
- Intermediate proficiency with managed care
Complete Job Description
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