California Licensed PM&R Physician

Job Summary

A company is looking for an Appeals M.D. - PM&R Physician - Remote.

Key Responsibilities

• Conduct clinical reviews and adjudications of appeals and grievances for 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, quality issues, and participate in team meetings for process improvement

Required Qualifications

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