Job Summary
A company is looking for an Appeals Medical Director, preferably for Pacific or Mountain Time, to work remotely.
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 management staff on access, network, and quality issues
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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