State Licensed Medical Director

Job Summary

Supporting the Medicaid Appeals team, the remote State Licensed Medical Director will manage member and provider appeals related to medical necessity, provide clinical expertise, and chair Medicaid appeals committee meetings.

Key responsibilities

• Ensure timely and consistent responses to member and provider appeals and escalated complaints
• Focus on clinical consultation for the Medicaid grievance and appeals team
• Chair or co-chair Medicaid appeals committee meetings

Required qualifications

• Five or more years of experience in a Health Care Delivery System
• Active state medical license without encumbrances and ability to obtain licensure in FL, KY, LA, and WV
• Board Certified in an ABMS Recognized Specialty
• M.D. or D.O. with post-graduate direct patient care experience