Remote Medical Director, Appeals

Location: Remote-MO

Salary: $236,500.00–$449,300.00 per year

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Assist the Chief Medical Director in directing medical management, utilization management, quality improvement, credentialing, and cost-containment functions.
• Perform medical reviews for utilization management, quality assurance, complex or controversial services, experimental treatments, claims, and medical necessity appeals.
• Lead or support quality improvement initiatives for capitated providers and identify adverse utilization trends, unusual practice patterns, and unwarranted clinical variation.
• Conduct regular rounds for high-risk patients and coordinate care with care management teams.
• Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on complex cases.
• Support physician committees, provider network development, market expansion, physician education, and representation before state or other committees.

Requirements

• Medical Doctor or Doctor of Osteopathy degree.
• Active practice of medicine and a current unrestricted state MD or DO license without government-program restrictions, limitations, or sanctions.
• Active board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.
• 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.
• Availability to work weekends and holidays when required by business operations.

Culture & Benefits

• Remote, hybrid, field, or office work schedules are supported.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Competitive pay with total compensation potentially including additional incentives.
• Pay is adjusted according to skills, experience, education, job-related factors, and full-time or part-time status.