Remote Medical Director, Appeals

Location: Remote-MO, United States

Salary: $236,500–$449,300 per year

Company

hirify.global provides healthcare services focused on improving access, quality, and cost-effectiveness of care.

What you will do

• Assist the Chief Medical Director with medical management, quality improvement, credentialing, and business-unit policy goals.
• Lead utilization management, cost-containment, medical quality improvement, and complex medical review activities.
• Review complex, controversial, experimental, unusual, or new services for medical necessity and appropriate payment.
• Conduct rounds for high-risk patients and coordinate care with care management teams, clinical teams, providers, appeals staff, and consultants.
• Support performance improvement initiatives, provider network development, market expansion, physician education, and committee activities.
• Identify utilization and quality improvement studies, adverse trends, unusual provider practice patterns, and opportunities to improve care outcomes.

Requirements

• Medical Doctor or Doctor of Osteopathy degree.
• Board certification in a specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.
• Current unrestricted state license as an MD or DO, without government-program restrictions, limitations, or sanctions.
• Active medical practice.
• Utilization management experience and knowledge of quality accreditation standards are preferred.
• Internal or Family Medicine certification and experience treating or managing care for culturally diverse populations are preferred.

Culture & Benefits

• Remote, hybrid, field, and office work schedules are supported depending on business needs.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Work may include weekends and holidays when required for business operations.
• Commitment to diversity and equal employment opportunity.