Appeals Medical Director - Remote

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, strengthening care quality, team performance, and measurable outcomes within a healthcare environment.

Location: Remote – US-based candidates only, no visa sponsorship available.

Responsibilities

• Perform clinical case reviews for appeals and grievances across various health plans
• Handle regulatory responses to insurance and managed healthcare departments
• Communicate decisions and rationales with medical directors
• Collaborate on network access and quality issue discussions
• Participate in team meetings for process improvement and training
• Provide clinical input on organizational projects and committees

Qualifications

• MD or DO with active, unrestricted license
• Board Certified in an ABMS or AOBMS specialty
• 5+ years of clinical practice experience
• 2+ years of Quality Management experience
• Intermediate proficiency in managed care
• Excellent telephonic and interpersonal communication skills
• Strong project management and data analysis skills
• Experience presenting to clinical and non-clinical audiences

Pay

$248,500 – $373,000 annually

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase options
• 401k contributions
• Flexibility to work remotely from anywhere in the U.S.