Appeals And Grievances Medical Director

Role: Responsible for clinical review and adjudication of appeals and grievances across various health plans and insurance products.

Responsibilities: Conduct individual case reviews, respond to regulatory agencies, communicate with medical directors and staff, participate in team meetings, and provide clinical and strategic input for organizational initiatives.

Qualifications: MD or DO with active, unrestricted license; Board certification in an ABMS or AOBMS specialty; 5+ years clinical practice; 2+ years in Quality Management; proficient in managed care, communication, project management, data analysis, and presentation skills; creative problem solver and team player.

Skills: Strong clinical knowledge, interpersonal and telephonic communication, data interpretation, and team collaboration.

Additional Info: Offers remote work flexibility, competitive compensation, comprehensive benefits, and opportunities for growth within a mission-driven organization committed to equitable, quality healthcare.