Corporate Medical Director, Grievances and Appeals

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

41 days ago

Salary

$246.1K - $344.2K / year

Seniority

Lead

Postgraduate Degree2 yrs expEnglish

Job Description

• Provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. • Advise executives to develop functional strategies on matters of significance. • Exercise independent judgment and decision making on complex issues regarding job duties and related tasks, and work under minimal supervision. • Conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type.

Job Requirements

  • MD or DO degree
  • 2 or more years of project leadership experience
  • A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
  • Board Certified in an approved ABMS Medical Specialty
  • Excellent communication skills
  • 5 years of established clinical experience post residency
  • Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
  • Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
  • Occasional holidays required

Benefits

  • Medical, dental and vision benefits
  • 401(k) retirement savings plan
  • Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • Short-term and long-term disability
  • Life insurance

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