MD Appeals Director
Virtual Vocations Inc, New York, NY, United States
A company is looking for an Appeals M.D. - Member Appeals to manage clinical reviews and adjudications of appeals and grievances cases.
Key Responsibilities
Perform individual case reviews for appeals and grievances across various health plan products Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS Collaborate with medical directors and management staff on access, availability, and quality issues
Required Qualifications
MD or DO with an active, unrestricted license Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics) 5+ years of clinical practice experience
Perform individual case reviews for appeals and grievances across various health plan products Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS Collaborate with medical directors and management staff on access, availability, and quality issues
Required Qualifications
MD or DO with an active, unrestricted license Board Certified in an ABMS or AOBMS specialty (excluding Pediatrics) 5+ years of clinical practice experience