What are the responsibilities and job description for the Appeals M.D. - Remote, Board-Certified in Med-Peds or FM position at Plan A Health?
The Appeals and Grievances Medical Director is responsible for clinical review and adjudication of appeals and grievances related to various health plan products, ensuring compliance with regulatory responses and applying medical policies.
They communicate with medical directors, regional teams, and network staff regarding benefit interpretations, access, and quality issues.
The role involves participating in team meetings, providing clinical and strategic input for organizational initiatives, and supporting process improvements.
Qualifications include an MD or DO with an active license, board certification in a non-pediatric specialty, and at least 5 years of clinical practice.
Preferred skills encompass quality management experience, managed care proficiency, strong communication, project management, data analysis, presentation skills, problem-solving, computer literacy, and teamwork.
Compensation ranges from $248,500 to $373,000, with benefits and performance-based incentives.
The position promotes a collaborative environment committed to improving healthcare quality and equity.
They communicate with medical directors, regional teams, and network staff regarding benefit interpretations, access, and quality issues.
The role involves participating in team meetings, providing clinical and strategic input for organizational initiatives, and supporting process improvements.
Qualifications include an MD or DO with an active license, board certification in a non-pediatric specialty, and at least 5 years of clinical practice.
Preferred skills encompass quality management experience, managed care proficiency, strong communication, project management, data analysis, presentation skills, problem-solving, computer literacy, and teamwork.
Compensation ranges from $248,500 to $373,000, with benefits and performance-based incentives.
The position promotes a collaborative environment committed to improving healthcare quality and equity.