For our client, we are seeking a Medical Director (medicare/Appeals) to join the team of a leader in the Healthcare space. This role will support clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution. The position offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a healthcare environment.
Location: Remote - US based candidates only, no visa sponsorship available
Compensation: $180,000 – $220,000 annually
Responsibilities
- Determine medical necessity and appropriateness of health services for members
- Support and evaluate the effectiveness of the utilization management program
- Educate providers on utilization practices and resource management
- Lead training and implementation of criteria for medical necessity
- Participate in the appeals process and investigate quality of care concerns
Qualifications
- 3+ years healthcare experience, including 2+ years in medical practice or equivalent education/experience
- Active and unrestricted MD or DO license in state of practice
- Board certification required
- Familiarity with national, state, and local laws affecting medical staff
- Strong organizational, time-management, and communication skills
Benefits
- Comprehensive health benefits package
- Paid time off and holidays
- Professional development opportunities
- Retirement savings plan options
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.
