MD Appeals Medical Director

Working remotely, the part-time Appeals MD Medical Director will manage clinical reviews and adjudications of appeals and grievances for various health plan products, ensuring compliance with medical policies and regulatory requirements. Key responsibilities: Perform individual case reviews for appeals and grievances related to medical services and benefit coverage Communicate with medical directors regarding appeals decision rationales and benefit interpretations Participate in team meetings and organizational committees to provide clinical and strategic input Required qualifications: MD or DO with an 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 with managed care and basic computer skills