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.

Key duties include performing case reviews, communicating decisions with internal teams, participating in team meetings, and providing clinical and strategic input on organizational initiatives.

Qualifications include an MD or DO with active license, board certification in a specialty, and at least 5 years of clinical practice, with 2+ years in Quality Management.

Skills required involve managed care proficiency, communication, project management, data analysis, presentation, creative problem-solving, and teamwork.

This role offers remote work flexibility, competitive compensation, and benefits supporting professional growth and work-life balance.