Appeals M.D. - Oncologist Needed - Remote

The Appeals and Grievances Medical Director is responsible for reviewing and adjudicating appeals and grievances related to medical services across various health plan products. They perform clinical case reviews, respond to regulatory agencies, and communicate decision rationales with internal teams, including medical directors and network staff. Key duties include participating in team meetings, providing clinical and strategic input on organizational initiatives, and ensuring compliance with regulatory requirements. Qualifications include an active MD or DO license, board certification in a relevant specialty, and at least 5 years of clinical practice experience, with a minimum of 2 years in Quality Management. Strong communication, project management, data analysis, and problem-solving skills are essential. Candidates should be proficient with managed care and computer applications. Compensation varies based on experience and location, with a comprehensive benefits package offered. Join a collaborative environment dedicated to improving healthcare quality and equity.