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Medical Appeals and Grievances Director - Reconsiderations
Job in
Killeen, Bell County, Texas, 76540, USA
Listed on 2026-08-07
Listing for:
DayToDay Health
Full Time
position Listed on 2026-08-07
Job specializations:
-
Dental / Dentistry
Healthcare Consultant
Job Description & How to Apply Below
Role Overview: A remote Medical Director overseeing appeals and grievances within health plans, focusing on medical service determinations, benefit coverage, and clinical criteria.
Key Responsibilities- Review individual appeals and grievances across various insurance products.
- Respond to regulatory inquiries from agencies like CMS and State Departments.
- Collaborate with medical directors and network staff on benefit interpretations, access, and quality issues.
- Participate in team meetings for communication, process improvement, and training.
- Contribute clinical and strategic insights to organizational committees and projects.
- MD or DO with active, unrestricted license and board certification in a non-pediatric specialty.
- Minimum of 5 years clinical practice and 2 years in Quality Management.
- Proficiency in managed care, computer applications, data analysis, and project management.
- Excellent communication, presentation, problem-solving, and team-building skills.
Salary range from $248,500 to $373,000, including base pay and bonus, with comprehensive benefits, incentives, and retirement options.
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