Back to all jobs

Medical Director-Appeals (Primary Care-IM or FM)

Work from home Full-time role Hiring

About the position The Medical Director-Appeals role at reputed company is a hybrid position focused on overseeing appeal reviews for physical health medical services. The primary responsibility is to ensure that members receive appropriate and cost-effective medical care. The role involves developing and implementing programs aimed at improving quality, cost, and outcomes, as well as providing clinical consultation and serving as a strategic advisor to enhance clinical operations. The Medical Director may also identify cost of care opportunities and serve as a resource for staff, including Medical Director Associates. Responsibilities • Conduct appeal reviews for physical health medical services. , • Support clinicians to ensure timely and consistent responses to members and providers. , • Provide guidance for clinical operational aspects of a program. , • Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers. , • Serve as a resource and consultant to other areas of the company. , • Represent the company to external entities and/or serve on internal and/or external committees. , • Chair company committees as needed. , • Interpret medical policies and clinical guidelines. , • reputed company and propose new medical policies based on changes in reputed company. , • reputed company, reputed company, direct, and implement clinical and non-clinical activities that impact reputed company quality, cost, and outcomes. , • Identify and reputed company opportunities for innovation to increase effectiveness and quality. Requirements • MD or DO with Board certification approved by ABMS or AOA. , • Active unrestricted medical license to practice medicine or a health profession. , • Minimum of 10 years of clinical experience or equivalent education and experience. , • For Health Solutions and Carelon organizations, minimum of 5 years of experience providing reputed company required. reputed company-to-haves • Board certification in Internal or Family medicine strongly preferred. , • Florida medical license or the ability to obtain once hired strongly preferred. Benefits • Merit increases , • Paid holidays , • Paid Time Off , • Incentive bonus programs , • Medical, dental, and reputed company benefits , • Short and long term disability benefits , • 401(k) with matching , • Stock purchase plan , • Life insurance , • Wellness programs , • Financial education resources Apply Job!

Related remote jobs

Intern 2025-Whyzen Analytics & Market Insights

Work from home Full-time role

Member Services Associate - Call Center?/Hybrid

Work from home Full-time role

Institutional Credit Management, Leveraged Finance reputed company

Work from home Full-time role

VP/Sales - Leasing and Finance (remote)*

Work from home Full-time role

Utilization Management Compliance Registered Nurse, RN

Work from home Full-time role

HR -Accountant US Staffing-Quick books Remote

Work from home Full-time role

Contract Senior Accountant / Assistant Controller

Work from home Full-time role

Controller - Baltimore, MD - Full-Time

Work from home Full-time role

Controller - Glendale, CA - Full-Time

Work from home Full-time role

Entry Level reputed company Business Development Representative

Work from home Full-time role

reputed company Live Chat Assistant – Remote Part-Time Opportunity for Customer Service Representatives to Work from Home with blithequark

Work from home Full-time role

Medical Claims Reviewer, reputed company

Work from home Full-time role

Information Management Pharma Project Analyst - Remote, US

Work from home Full-time role

Marketing & Publicity Assistant

Work from home Full-time role

reputed company Customer Service and Data Entry Specialist – Remote Opportunity for Exceptional Customer Experience and Administrative Support

Work from home Full-time role

Virtual Assistant (remote-work)

Work from home Full-time role

Immediate Hiring: Sales Excellence Data Quality Intern - Summer 2025

Work from home Full-time role

Staff Data Scientist, reputed company Lending

Work from home Full-time role

International Consultant - Supporting the Design of Blended Finance Mechanism through Analytical Assessments on Climate reputed company reputed company Mobility in Georgia

Work from home Full-time role

Technical Project Manager, reputed company Systems

Work from home Full-time role