California Licensed Medical Director - job 1 of 2

Job Summary

A company is looking for a Medical Director - Commercial Appeals.

Key Responsibilities

• Oversee medical policy implementation and support Medical Management staff
• Review appeal cases for denied medical services, including various levels of appeals
• Provide clinical, coding, and reimbursement expertise while acting as a liaison to network providers

Required Qualifications

• Two or more years of experience in Health Care Delivery System, including clinical practice and health care industry
• Prior Utilization Management (UM) experience
• Active and current state medical license without encumbrances
• M.D. or D.O. with Board Certification in an ABMS or AOA recognized specialty
• Post-graduate direct patient care experience