Appeals M.D. - Oncologist - Remote

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 agencies. They perform case reviews, communicate decisions and benefit interpretations with medical directors and network staff, and contribute to team meetings focused on process improvement and staff training. The role involves providing clinical and strategic input on organizational projects and committees. Qualifications include an MD or DO with an active license, board certification, 5+ years of clinical practice, and 2+ years in Quality Management. Skills in managed care, communication, project management, data analysis, and presentation are essential. The position offers remote work flexibility, competitive compensation, comprehensive benefits, and opportunities for professional growth. The organization promotes diversity, equity, and inclusion, aligning with its mission to improve health outcomes for all.