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State Licensed Appeals Medical Director

7/9/2025

Remote

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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