Appeals Medical Director – Cardiology

Role Overview

• Responsible for the appeal reviews for physical health medical services
• Supports clinicians to ensure timely and consistent responses to members and providers
• Provides guidance for clinical operational aspects of a program
• Conducts peer-to-peer clinical case reviews with attending physicians
• Serves as a resource and consultant for other areas of the company
• May chair company committees
• Interprets medical policies and clinical guidelines
• Identifies and develops opportunities for innovation to increase effectiveness and quality

Requirements

• Requires MD or DO, Board certification by ABMS or AOA is required
• Must possess an active unrestricted medical license to practice medicine
• Minimum of 10 years of clinical experience; or any combination of education and experience that provides equivalent background
• For Health Solutions and Carelon organizations, minimum of 5 years of experience providing health care is required
• Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid Time Off
• Medical, dental, vision insurance
• Short and long-term disability benefits
• Wellness programs
• Financial education resources