The Appeals and Grievances Medical Director is responsible for clinical review and adjudication of appeals and grievances across various health plan products, ensuring compliance with regulatory agencies and interpreting benefit policies.

They communicate with medical directors, network management, and organizational teams to address access, quality, and coverage issues.

This role involves participating in team meetings, providing clinical and strategic input for organizational projects, and improving processes through feedback and problem-solving.

Qualifications: MD or DO with active license, board certification in an ABMS or AOBMS specialty, 5+ years clinical practice, 2+ years in Quality Management, managed care proficiency, excellent communication, project management, data analysis, presentation, and team skills.

Remote work flexibility is offered, with compensation ranging from $248,500 to $373,000 plus benefits. The role aims to improve healthcare delivery and promote health equity.