MD Appeals Medical Director

A company is looking for an Appeals M.D. - Member Appeals to perform clinical reviews and adjudications of appeals and grievances cases.

Key Responsibilities

Conduct individual case reviews for appeals and grievances related to various health plan products

Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS

Collaborate with medical directors and staff on access, network, and quality issues while participating in team meetings

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