What are the responsibilities and job description for the Appeals M.D. - Remote position at Health Marketing?
Role: The Appeals and Grievances Medical Director oversees clinical review and adjudication of appeals and grievances related to various health plan products, ensuring compliance with regulatory agencies and providing clinical and strategic input on organizational initiatives.
Responsibilities: Conduct individual case reviews, communicate appeal decisions and benefit interpretations, collaborate with medical directors and staff on access and quality issues, participate in team meetings for process improvement, and contribute to organizational committees and projects.
Qualifications: MD or DO with active, unrestricted license; Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics); 5 years of clinical practice experience.
Preferred Skills: 2 years in Quality Management, managed care proficiency, excellent communication, project management, data analysis, presentation skills, creative problem-solving, computer literacy, and team-building abilities.
This role offers remote work flexibility, a competitive compensation range, comprehensive benefits, and opportunities for professional growth in a dynamic healthcare environment.
Responsibilities: Conduct individual case reviews, communicate appeal decisions and benefit interpretations, collaborate with medical directors and staff on access and quality issues, participate in team meetings for process improvement, and contribute to organizational committees and projects.
Qualifications: MD or DO with active, unrestricted license; Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics); 5 years of clinical practice experience.
Preferred Skills: 2 years in Quality Management, managed care proficiency, excellent communication, project management, data analysis, presentation skills, creative problem-solving, computer literacy, and team-building abilities.
This role offers remote work flexibility, a competitive compensation range, comprehensive benefits, and opportunities for professional growth in a dynamic healthcare environment.