Appeals Medical Director – Medicare

About the Role

The Appeals Medical Director – Medicare oversees appeal reviews related to physical health medical services, ensuring the delivery of appropriate, cost-effective care.

Responsibilities

• Conduct appeal reviews for Medicare-related physical health services.
• Support clinicians in providing timely responses to appeals.
• Provide clinical guidance and perform peer-to-peer reviews.
• Interpret and develop medical policies.
• Lead initiatives to improve healthcare quality, cost, and outcomes.

Requirements

• MD or DO degree with Board certification from ABMS or AOA.
• Active, unrestricted medical license.
• Minimum of 10 years of clinical experience (5 years may be considered for certain health organizations).

Preferred Qualifications

• Background in primary care specialties.
• Experience in utilization management or appeals.

Additional Information

This role offers flexibility to work virtually with required in-person training. Available in several states.

Pay

Compensation ranges from $247,840 to $446,112 annually.

Benefits

Comprehensive benefits package included.