Medical Director - Commercial Appeals
6 days ago
Description
• Remote based role requiring a California medical license. • Provide oversight for medical policy implementation. • Support Medical Management staff for timely responses to members and providers. • Review appeal cases for denied medical services. • Provide clinical, coding, and reimbursement expertise as needed. • Act as a business and clinical liaison to network providers.
Requirements
• Two (2) or more years of experience in Health Care Delivery System. • Prior UM (Utilization Management) experience. • Active and current state medical license in CA without encumbrances and willing to obtain an AZ medical license. • M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience. • Internal Medicine background preferred. • Experience in Medicare and Medicaid preferred.
Benefits
• Full range of medical, dental, and vision benefits. • Eligible employees may enroll in the Company’s 401(k) retirement savings plan. • Employee Stock Purchase Plan available for eligible employees. • Fully-paid term life insurance plan to eligible employees. • Short-term and long-term disability benefits. • Numerous well-being programs, education assistance, and free development courses. • CVS store discount and discount programs with participating partners. • Paid Time Off (“PTO”) and paid holidays throughout the calendar year.
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