State Licensed Plastic Surgeon

Job Summary

To support clinical operations, a State Licensed Plastic Surgeon will work remotely to manage the review and adjudication of appeals and grievances cases, ensuring compliance with medical policies and regulatory standards.

Key responsibilities

• Perform individual case reviews for appeals and grievances related to various health plan products
• Communicate with medical directors regarding appeals decision rationales and benefit interpretations
• Participate in team meetings focused on process improvement, staff training, and organizational projects

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
• Familiarity with current medical issues and practices