Job Summary
A company is looking for an Appeals MD - Plastic Surgeon.
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 organizational committees
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 proficiency with managed care
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