State Licensed Plastic Surgeon Appeals and Grievances Medical Director

Job Summary

A company is looking for an Appeals and Grievances Medical Director - Plastic Surgeon.

Key Responsibilities:

• Perform individual case review for appeals and grievances related to medical services
• Communicate with medical directors and network management staff regarding appeals decisions and benefit interpretations
• Participate in team meetings, committees, projects, and task forces

Required Qualifications:

• MD or DO with an active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty
• 5+ years clinical practice experience
• 2+ years Quality Management experience
• Intermediate or higher level of proficiency with managed care