For our client, we are seeking a Appeals Medical Director - Onc/Rad-Onc/EM/IM/Optho Required - Remote to join the team of a leader in the Healthcare space.
This physician leadership role will focus on clinical appeals and grievances review within managed care, with an emphasis on applying sound medical judgment to complex coverage decisions. The position also involves partnering with medical leadership and regulatory stakeholders to support quality, access, and process improvement across health plan operations. It is a remote opportunity with meaningful influence on clinical policy, consistency, and member outcomes.
Location: Remote - US based candidates only, no visa sponsorship available
Compensation: $248,500 – $373,000 annually
Responsibilities
- Perform individual case review for appeals and grievances across various health plan products
- Respond to regulatory inquiries from Departments of Insurance, Managed Healthcare, and CMS
- Communicate appeals decision rationales to medical directors
- Engage with Regional and Plan medical directors about access, availability, and quality issues
- Participate in team discussions focused on problem solving and process improvement
- Provide clinical and strategic input in organizational committees and projects
Qualifications
- MD or DO with an active, unrestricted license
- Board Certified in an ABMS or AOBMS specialty
- 5+ years of clinical practice experience
- 2+ years of Quality Management experience
- Familiarity with current medical issues and practices
- Excellent telephonic and interpersonal communication skills
- Intermediate or higher proficiency with managed care
Benefits
- Flexible remote work opportunity from anywhere in the U.S., with some in-office requirements for Minneapolis or D.C. hires
- Comprehensive benefits package including health and wellness programs
- Incentive and recognition programs
- Opportunity for equity stock purchase and 401k contributions
- Strong professional development focus with clear progression paths
- A collaborative team culture that values support and teamwork
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.
