What are the responsibilities and job description for the Appeals Medical Director – Medicare position at Health Care Administrators Association® (HCAA)?
Role Overview: The Appeals Medical Director – Medicare is responsible for reviewing appeals related to physical health medical services, ensuring appropriate and cost-effective care.
Key Responsibilities: Conduct appeal reviews, support clinicians for timely responses, provide clinical guidance, perform peer-to-peer case reviews, interpret and develop medical policies, and lead initiatives to improve quality, cost, and outcomes.
Qualifications & Skills: Must hold an MD or DO with board certification (ABMS or AOA), active unrestricted medical license, and at least 10 years of clinical experience. Preferred candidates have primary care specialties and utilization management or appeals experience.
Additional Details: Role offers flexible virtual work, with in-person training, and may involve representing the organization externally or chairing committees. The position is at a director level, with a salary range of $247,840 to $446,112, and requires location in specific U.S. states. Benefits include comprehensive packages, incentives, and retirement options.
Key Responsibilities: Conduct appeal reviews, support clinicians for timely responses, provide clinical guidance, perform peer-to-peer case reviews, interpret and develop medical policies, and lead initiatives to improve quality, cost, and outcomes.
Qualifications & Skills: Must hold an MD or DO with board certification (ABMS or AOA), active unrestricted medical license, and at least 10 years of clinical experience. Preferred candidates have primary care specialties and utilization management or appeals experience.
Additional Details: Role offers flexible virtual work, with in-person training, and may involve representing the organization externally or chairing committees. The position is at a director level, with a salary range of $247,840 to $446,112, and requires location in specific U.S. states. Benefits include comprehensive packages, incentives, and retirement options.
Salary : $247,840 - $446,112