Appeals Physician - Remote

The Appeals and Grievances Medical Director is responsible for clinical review and adjudication of appeals and grievances across various health plan products, addressing adverse determinations related to medical services and coverage policies.

They communicate decision rationales with medical directors, regional teams, and network management, and participate in meetings focused on process improvement, training, and program outcomes.

The role involves providing clinical and strategic input on organizational projects and committees.

Qualifications include an MD or DO license, board certification in a non-pediatric specialty, and a minimum of 5 years of clinical practice.

Preferred skills encompass quality management, managed care proficiency, excellent communication, project management, data analysis, presentation skills, and team collaboration.

This role offers remote work flexibility and a competitive salary with benefits, contributing to a mission of improving healthcare quality, equity, and patient outcomes.