What are the responsibilities and job description for the Appeals and Grievances Medical Director Reconsiderations position at Health Care Administrators Association® (HCAA)?
Role: The Appeals and Grievances Medical Director reviews appeals and grievances related to various health plans, ensuring adherence to clinical criteria and regulatory standards.
Responsibilities: Conduct individual case reviews, respond to regulatory agencies, communicate clinical and benefit decisions with internal teams, participate in team meetings, and provide input on organizational initiatives.
Qualifications: MD or DO with active license, board certification in a non-pediatric specialty, at least 5 years of clinical practice, 2 years in Quality Management, and proficiency in managed care, data analysis, project management, and communication skills.
Skills: Strong presentation, telephonic, interpersonal, problem-solving, and team-building abilities, along with basic computer literacy and research skills.
Additional Info: The role offers remote work, competitive compensation, benefits, and opportunities for professional growth, emphasizing a collaborative environment focused on improving healthcare quality and accessibility.
Responsibilities: Conduct individual case reviews, respond to regulatory agencies, communicate clinical and benefit decisions with internal teams, participate in team meetings, and provide input on organizational initiatives.
Qualifications: MD or DO with active license, board certification in a non-pediatric specialty, at least 5 years of clinical practice, 2 years in Quality Management, and proficiency in managed care, data analysis, project management, and communication skills.
Skills: Strong presentation, telephonic, interpersonal, problem-solving, and team-building abilities, along with basic computer literacy and research skills.
Additional Info: The role offers remote work, competitive compensation, benefits, and opportunities for professional growth, emphasizing a collaborative environment focused on improving healthcare quality and accessibility.