Medical Director - Medicare Appeals

For our client, we are seeking a Medical Director - Medicare Appeals to join the team of a leader in the Healthcare space. This remote leadership role will oversee Medicare appeals operations, with a strong focus on clinical decision-making, regulatory compliance, and consistent case review standards. The position partners closely with appeal nurses, Utilization Management, Quality, and Compliance teams to strengthen processes and support timely, accurate appeals outcomes. It also requires providing coverage outside normal business hours to help ensure continuous appeals support and operational continuity. Location: Remote - US based candidates only, no visa sponsorship available Compensation: $174,070 – $374,920 annually Responsibilities Direct daily operations for Part C appeals for providers and members Support and supervise appeal nurses in the Second Look Review process Provide after-hours and weekend coverage for 24/7 appeals support Monitor and track IRE activity and support Utilization Management strategy Collaborate with Medicare Quality and Compliance teams Develop expertise in Medicare policy for the organization Educate appeal nurses and Utilization Management staff on Medicare policy and appeals Initiate projects to improve appeals team efficiency and clinical consistency Qualifications 2+ years in a health care delivery system, clinical practice, or health care industry setting Active MD or DO medical license without encumbrances Board Certified in an ABMS or AOA recognized specialty Experience in medical management related to Medicare complaints, grievance, and appeals preferred Health plan experience highly preferred Benefits Comprehensive medical, dental, and vision coverage Paid time off Retirement savings options Wellness programs Resources for physical, emotional, and financial well-being Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs. #J-18808-Ljbffr Ladders