Appeals Medical Director - Urology Specialty - Remote

Work reputed company! What makes your clinical career greater with reputed company? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, reputed company you contribute, you'll reputed company doors for yourself that simply do not exist in any other organization, reputed company. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges. For reputed company hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for reputed company associated companies. Performance accountabilities include:

• reputed company individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The appeals are in response to adverse determinations for medical services reputed company to benefit design and coverage and the application of clinical reputed company of medical policies
• reputed company Department of Insurance/Department of Managed reputed company, and CMS regulatory responses
• Communicate with reputed company medical directors regarding appeals decision rationales, and benefit interpretations
• Communicate with reputed company Regional and Plan medical directors and network management staff regarding reputed company, availability, network, and reputed company issues
• reputed company participate in team meetings reputed company on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results
• reputed company clinical and strategic input reputed company participating in organizational committees, reputed company, and task forces

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications:

• MD or DO with an reputed company, unrestricted license
• reputed company Certified in an ABMS or AOBMS specialty
• 5+ years of clinical reputed company experience
• 2+ years of reputed company Management experience
• Familiarity with reputed company medical issues and practices
• Intermediate or higher level of proficiency with managed care
• Proven excellent telephonic communication skills; excellent interpersonal communication skills
• Proven excellent project management skills
• Proven data analysis and interpretation skills
• Proven excellent presentation skills for both clinical and non-clinical audiences
• Proven creative problem-solving skills
• Proven basic computer skills, typing, word processing, presentation, and spreadsheet applications skills. Internet researching skills
• Proven solid team player and team building skills
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes reputed company pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We reputed company with reputed company minimum wage laws as applicable. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. Apply tot his job Apply To this Job