Medical Director, Appeals

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Support the Chief Medical Director in overseeing and coordinating medical management, quality improvement, and credentialing activities.

• Offer medical leadership for utilization management, cost containment, and initiatives aimed at enhancing medical quality.

• Engage in medical review tasks related to utilization review, quality assurance, and complex medical services.

• Aid in the effective execution of performance improvement initiatives for capitated provider groups.

• Contribute to the planning and establishment of goals and policies to enhance the quality and cost-effectiveness of care.

• Provide medical expertise in the operation of sanctioned quality improvement and utilization management programs.

• Assist in the operations of physician committees.

• Conduct regular rounds to evaluate and coordinate care for high-risk patients.

• Work in collaboration with clinical teams, network providers, and medical consultants to review complex cases.

• Engage in provider network development and market expansion efforts.

• Design and implement physician education programs addressing clinical issues.

⛳️ Requirements

• Medical Doctor (MD) or Doctor of Osteopathy (DO) degree.

• Experience in Utilization Management and familiarity with quality accreditation standards is preferred.

• Actively practicing medicine is a requirement.

• Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.

• Experience in treating or managing care for a culturally diverse population is preferred.

• Current Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.

• Certification in Internal or Family Medicine specialty is preferred.

• Possess a current state license as an MD or DO with no restrictions, limitations, or sanctions from government programs.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.