Appeals M.D. - Oncologist Required - Remote

Appeals And Grievances Medical Director Role: Responsible for clinical review and adjudication of appeals and grievances across various health plan products, ensuring compliance with regulatory bodies and providing benefit interpretations. Key Responsibilities Perform individual case reviews related to adverse medical service determinations.Communicate decision rationales with medical directors and network management teams.Participate in team meetings, organizational committees, and projects to improve processes and share program results.Provide clinical and strategic input for organizational initiatives. Qualifications & Skills MD or DO with active, unrestricted license and board certification in an ABMS or AOBMS specialty.Minimum of 5 years clinical practice and 2 years in Quality Management.Proficiency in managed care, data analysis, project management, and communication skills.Experience with regulatory responses and current medical practices is preferred. Additional Information: Offers remote work, competitive compensation, benefits, and opportunities for professional growth in a collaborative environment focused on equitable healthcare.