California Licensed Appeals Medical Director

Job Summary

A company is looking for an Appeals M.D. in Family or Internal Medicine, with remote work options available.

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
• Engage in team meetings and provide clinical input for organizational committees and 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
• Intermediate or higher proficiency with managed care