What are the responsibilities and job description for the Appeals and Grievances Medical Director Reconsiderations - Remote position at Massachusetts Health & Hospital Association?
Appeals And Grievances Medical Director
Role: Provide clinical review for appeals and grievances across various health plan products, addressing adverse determinations related to medical services, coverage, and clinical criteria.
Responsibilities: Communicate with medical directors and network teams on benefit interpretations, access, quality, and network issues. Participate in team meetings for process improvement, training, and program outcomes. Contribute clinical and strategic insights to organizational committees and projects.
Qualifications & Skills: MD or DO with active license, board-certified in an ABMS or AOBMS specialty (excluding Pediatrics), with 5 years clinical practice and 2 years in Quality Management. Proficient in managed care, computer skills, presentation, telephonic communication, project management, data analysis, problem-solving, and team collaboration. Familiar with current medical practices and policies.
Compensation & Benefits: Salary range from $248,500 to $373,000, including base pay and bonuses, plus comprehensive benefits, incentives, and retirement options.
This role offers remote work flexibility and an inclusive, performance-driven environment focused on healthcare improvement.
Role: Provide clinical review for appeals and grievances across various health plan products, addressing adverse determinations related to medical services, coverage, and clinical criteria.
Responsibilities: Communicate with medical directors and network teams on benefit interpretations, access, quality, and network issues. Participate in team meetings for process improvement, training, and program outcomes. Contribute clinical and strategic insights to organizational committees and projects.
Qualifications & Skills: MD or DO with active license, board-certified in an ABMS or AOBMS specialty (excluding Pediatrics), with 5 years clinical practice and 2 years in Quality Management. Proficient in managed care, computer skills, presentation, telephonic communication, project management, data analysis, problem-solving, and team collaboration. Familiar with current medical practices and policies.
Compensation & Benefits: Salary range from $248,500 to $373,000, including base pay and bonuses, plus comprehensive benefits, incentives, and retirement options.
This role offers remote work flexibility and an inclusive, performance-driven environment focused on healthcare improvement.
Salary : $248,500 - $373,000