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California Licensed Pulmonology Medical Director
A company is looking for an Appeals and Grievances Medical Director specializing in Pulmonology for a remote position. Key Responsibilities Conduct individual case reviews for appeals and grievances related to various health plan products Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS Collaborate with medical directors and network management on access, availability, and quality issues Required Qualifications MD or DO with an active, unrestricted license Pulmonology Board Certified in an ABMS or AOBMS specialty 5+ years of clinical practice experience 2+ years of Quality Management experience Intermediate or higher proficiency with managed care
A company is looking for an Appeals and Grievances Medical Director specializing in Pulmonology for a remote position.
Key Responsibilities
Conduct individual case reviews for appeals and grievances related to various health plan products
Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
Collaborate with medical directors and network management on access, availability, and quality issues
Required Qualifications
MD or DO with an active, unrestricted license
Pulmonology Board Certified in an ABMS or AOBMS specialty
5+ years of clinical practice experience
2+ years of Quality Management experience
Intermediate or higher proficiency with managed care