Medical Director (Appeals)

Health Care Service Corporation; Chicago (IL); On-site; USD 192,000 - 356,000; Full time

Job summary

Health Care Service Corporation is seeking a physician-lead to oversee medical policies and programs from a remote location. You will review cases, engage with provider communities, and shape policy direction to support quality care.

This role requires a U.S. license, board certification in a primary specialty, and at least five years of clinical experience. Strong analytical, writing, and strategic skills are essential for success.

Qualifications

• MD or DO with active, unrestricted U.S. physician license.
• Board certification by ABMS, NBPM, or ABO Specialty Boards.
• Minimum 5 years of clinical experience.
• Strong analytical and communication skills; strategic thinking.

Responsibilities

• This role is responsible for assigned aspects of medical policies and programs.
• Performs medical reviews and interacts with provider communities.
• Collaborates with internal teams to implement policy changes.

Skills

Physician license

Board certification

Clinical experience

Analytical skills

Communication skills

Strategic thinking

MS Office

Lotus Notes

Tools

MS Office

Lotus Notes

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas.

Job Requirements

• Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
• Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
• 5 years of clinical experience
• Analytical and communication skills
• Strategic thinking skills
• Proficiency in computer skills (including software applications such as Microsoft Office Product and Lotus Notes) needed for electronic documentation of case reviews

Preferred Requirements

• 3 years Managed Care experience
• Cardiology, Gastroenterology, Rheumatology, Dermatology, Hematology, Oncology and internal medicine specialties preferred but nt required

This is a remote work from home role

Compensation: $191,500.00 - $355,600.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.