Appeals Medical Director – Medicare

About the Role

The Appeals Medical Director – Medicare reviews appeals related to physical health medical services, ensuring appropriate and cost-effective care. This role involves supporting clinicians, providing clinical guidance, and leading initiatives to improve quality, cost, and outcomes.

Responsibilities

• Conduct appeal reviews for Medicare-related physical health services
• Support clinicians to ensure timely responses to appeals
• Provide clinical guidance and perform peer-to-peer case reviews
• Interpret and develop medical policies
• Lead initiatives aimed at improving quality, cost, and outcomes
• Represent the organization externally or chair committees as needed

Requirements

• MD or DO degree with board certification (ABMS or AOA)
• Active, unrestricted medical license
• Minimum of 10 years of clinical experience
• Preferred: Primary care specialty and experience in utilization management or appeals

Additional Details

This is a director-level, virtual role with occasional in-person training. Location must be in specific U.S. states.

Pay

Salary range: $247,840 to $446,112.

Benefits

• Comprehensive benefits package
• Incentives
• Retirement options