Appeals Medical Director – Medicare
Health Care Administrators Association® (HCAA) · Indianapolis, IN · 2 mo ago
$248k–$446k/yrFull-time
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