Medical Director (Medicare/Appeals)

For a leader in the healthcare space, we are seeking a Medicare/Appeals Medical Director to support clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. This role offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a healthcare environment.

About the role

You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution.

Responsibilities

• Determine medical necessity and appropriateness of health services for members
• Support and evaluate the effectiveness of the utilization management program
• Educate providers on utilization practices and resource management
• Lead training and implementation of criteria for medical necessity
• Participate in the appeals process and investigate quality of care concerns

Requirements

• 3+ years healthcare experience, including 2+ years in medical practice or equivalent education/experience
• Active and unrestricted MD or DO license in state of practice
• Board certification required
• Familiarity with national, state, and local laws affecting medical staff
• Strong organizational, time-management, and communication skills

Benefits

• Comprehensive health benefits package
• Paid time off and holidays
• Professional development opportunities
• Retirement savings plan options

Pay

$180,000 – $220,000 annually

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