Appeals Medical Director – Medicare

Location: Columbus, OH – US based candidates only, no visa sponsorship available.

About the Role

This role supports clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution. The position offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a healthcare environment.

Responsibilities

• Conduct appeal reviews for physical health medical services
• Support clinicians with timely member and provider responses
• Provide guidance on operational program aspects
• Conduct peer-to-peer clinical case reviews
• Serve as a resource to various company areas
• Represent the company to external organizations
• Lead and implement activities affecting healthcare quality and outcomes

Qualifications

• MD or DO with Board certification from ABMS or AOA required
• Active, unrestricted medical license to practice
• Minimum of 10 years of clinical experience required
• 5 years of healthcare experience required for specific organizations (experience may vary based on state contracts or regulations)

Pay

$247,840 – $446,112 annually

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase options
• 401k contribution opportunities
• Flexible remote work arrangement with in-person training