Corporate MD Grievance & Appeals (Healthcare)

Location: Fully remote within the USA; occasional travel to hirify.global offices for training or meetings may be required. Typical hours are Monday–Friday, 8 hours per day, with holiday and weekend coverage as needed.

Salary: $246,100–$344,200 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and insurance company serving Medicare, Medicaid, individual, family, military, and community populations through hirify.global and CenterWell services.

What you will do

• Review or oversee grievance and appeal cases across Medicare, Medicaid, and Commercial products.
• Provide medical interpretation and clinical judgment on the appropriateness, necessity, and quality of healthcare services.
• Make independent determinations on complex cases involving incomplete information or competing clinical considerations.
• Support reviews involving home health, rehabilitation, inpatient, outpatient, and transitional care.
• Partner with cross-functional teams to improve consistency, turnaround times, compliance, and member-centered decisions.
• Monitor regulatory, accreditation, and medical policy changes affecting review determinations.

Requirements

• MD or DO degree and board certification in an approved ABMS medical specialty.
• Current, unrestricted medical license in at least one jurisdiction and willingness to obtain additional unrestricted state licenses as required.
• At least 5 years of clinical experience after residency.
• No current federal or state government sanctions and ability to pass credentialing requirements.
• Knowledge of managed care, Medicare, Medicaid, or Commercial healthcare products.
• Strong written and verbal professional communication skills.

Nice to have

• Medical utilization management experience in Medicare Advantage grievances and appeals.
• Experience with health insurance organizations, hospitals, healthcare providers, or patient interaction.
• Clinical specialization in internal medicine, family practice, geriatrics, hospital medicine, anesthesiology, physical medicine and rehabilitation, emergency medicine, neurology, or general surgery.

Culture & Benefits

• Fully remote work with a dedicated workspace that protects member PHI and HIPAA information.
• Home internet requirements include at least 25 Mbps download and 10 Mbps upload speeds.
• Medical, dental, and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.
• 40 scheduled hours per week with some flexibility depending on business needs.
• Minimal travel for training, meetings, or conferences, with after-hours, holiday, and weekend coverage when required.

Hiring process

• After application prescreening, selected candidates complete a 10–15-minute on-demand assessment through HireVue.
• Successful candidates proceed to subsequent interview rounds.
• Formal offer recipients enter their SSN in Workday for duplicate-profile screening.