The Appeals and Grievances Medical Director is responsible for clinical review and adjudication of appeals and grievances related to various health plan products, ensuring compliance with regulatory agencies such as CMS and state departments.

They communicate with medical directors, regional staff, and network management to address access, quality, and benefit interpretation issues.

The role involves participating in team meetings, providing clinical and strategic input on organizational initiatives, and contributing to process improvements.

Qualifications include an active MD or DO license, board certification, 5+ years of clinical practice, 2+ years in quality management, and proficiency in managed care, data analysis, and project management.

The position offers remote work flexibility and competitive compensation, with benefits supporting professional growth and development.

Ideal candidates are collaborative, problem-solvers with excellent communication and presentation skills.