What are the responsibilities and job description for the Appeals M.D. - Oncologist Needed - Remote position at Proforma Health?
The Appeals and Grievances Medical Director is responsible for clinical review and adjudication of appeals and grievances related to various health insurance products, ensuring compliance with regulatory responses and providing benefit interpretations.
They communicate with medical directors, regional teams, and network management to address access, quality, and coverage issues.
Key duties include performing case reviews, participating in team meetings, and contributing to organizational projects and committees.
Qualifications: MD or DO with active license, board certification, 5 years clinical practice, 2 years in Quality Management, managed care proficiency, strong communication, project management, data analysis, presentation, and problem-solving skills.
This role offers remote work, competitive compensation, and benefits, focusing on improving healthcare quality and equity.
They communicate with medical directors, regional teams, and network management to address access, quality, and coverage issues.
Key duties include performing case reviews, participating in team meetings, and contributing to organizational projects and committees.
Qualifications: MD or DO with active license, board certification, 5 years clinical practice, 2 years in Quality Management, managed care proficiency, strong communication, project management, data analysis, presentation, and problem-solving skills.
This role offers remote work, competitive compensation, and benefits, focusing on improving healthcare quality and equity.