California Licensed Pulmonologist
VirtualVocationsGarden Grove, California, United Statesjob_description.job_card.variable_hours_ago
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A company is looking for an Appeals M.D. - Pulmonologist to manage clinical reviews and adjudications of appeals and grievances cases.
Key Responsibilities
Conduct individual case reviews for appeals and grievances related to various health plan products
Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
Collaborate with medical directors and staff on access, availability, and quality issues
Required Qualifications
MD or DO with an active, unrestricted license
Board Certified in an ABMS or AOBMS specialty
5+ years of clinical practice experience
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Pulmonologist • Garden Grove, California, United States