Appeals Oncologist - Remote

The Appeals and Grievances Medical Director is responsible for clinical review and adjudication of appeals and grievances across various health plan products, ensuring compliance with regulatory agencies like CMS and state departments. They communicate clinical decisions and benefit interpretations with medical directors, regional teams, and network staff, contributing to process improvements, staff training, and organizational committees. Required qualifications include an MD or DO with an active license, board certification, and extensive clinical and quality management experience. The role demands strong communication, project management, data analysis, presentation, and problem-solving skills, with proficiency in managed care and basic computer applications. Offering a competitive compensation package, the position allows remote work and emphasizes improving healthcare quality, equity, and system responsiveness.