Medical Director
$167,500–$229,750 year
Remote · United States
Job Summary
Medical Director provides clinical oversight and governance for the medical review program, including appeals, rescission, and grievance panel processes; conducts comprehensive clinical reviews for first and second-level appeals; evaluates complex medical cases for consistency with policy provisions, clinical guidelines, and regulatory requirements; offers independent clinical judgment in coverage determinations and high-risk decisions; collaborates with legal, product, and actuarial teams, and supports the integration of AI and automation into medical review workflows; leads evaluation of rescission cases and member grievances, and documents rationale suitable for regulatory review. The role partners with stakeholders to align on priorities and drive efficiency and quality across medical management activities.
Required Qualifications
- 4 year Bachelors Degree (Required)
- MD or DO (Required)
- 8 or more years of experience (Required)
- Active and unrestricted license to practice medicine (Required)
Additional Requirements
- H-1B sponsorship not offered
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