MD Appeals Medical DirectorVirtualVocations • Modesto, California, United States
MD Appeals Medical Director
VirtualVocations • Modesto, California, United States
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A company is looking for an Appeals M.D. - Member Appeals to perform 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, network, and quality issues while participating in team meetings
Required Qualifications
MD or DO with an active, unrestricted license
Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics)
5+ years of clinical practice experience
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