Medical Director – Grievances & Appeals

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

📋 Description

• Deliver clinical evaluations and assessments regarding the medical suitability of services provided by healthcare professionals.

• Render independent, prompt, and justifiable medical judgments on intricate appeal matters.

• Collaborate with diverse teams, including legal, compliance, and clinical operations.

• Engage in quality enhancement initiatives, recognizing patterns in grievances and appeals.

• Act as a clinical resource for staff handling grievances and appeals.

• Keep abreast of current Medicare regulations, managed care standards, and industry best practices.

⛳️ Requirements

• MD or DO degree obtained from an accredited institution in the USA.

• A valid and unrestricted license in at least one jurisdiction.

• Board Certified in a recognized ABMS/ABOA Medical Specialty.

• Minimum of 5 years of clinical experience post-residency.

• Familiarity with the managed care sector, including Medicare, Medicaid, and/or Commercial products.

• Experience in discharge planning and/or home health or rehabilitation services.

🏝️ Benefits

• Medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off, including company holidays, personal holidays, and paid parental and caregiver leave.

• Short-term and long-term disability insurance.

• Life insurance.