Appeals Medical Director – Oncology
$247,840–$446,112 year
On-siteChicago, Illinois, United States or Durham, North Carolina, United States
Job Summary
Conduct appeal reviews for physical health medical services to ensure appropriate, cost-effective care and support clinicians with timely responses. Interpret medical policies and clinical guidelines, developing new policies based on healthcare changes. Lead clinical and non-clinical activities impacting quality, cost, and outcomes by conducting peer-to-peer case reviews and serving as a strategic advisor. Identify cost-of-care opportunities and represent the company to external entities or chair internal committees. Requires an MD or DO with board certification, an active unrestricted license, and minimum 10 years of clinical experience. Salary range $247,840 to $446,112. Full-time virtual work with required in-person training sessions.
Required Qualifications
- MD or DO
- Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA)
- Active unrestricted medical license to practice medicine or a health profession
- Located in a state or territory of the United States when conducting utilization review or an appeals consideration
- Not located on a US military base, vessel or any embassy located in or outside of the US
- Minimum of 10 years of clinical experience
- Any combination of education and experience, which would provide an equivalent background
- Minimum of 5 years of experience providing health care (for Health Solutions and Carelon organizations including behavioral health only)
Desired Qualifications
- Board certification in Oncology or Hematology and Oncology
- Utilization Management or Appeals experience
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