Medical Director (Appeals)

HCSC Group; United States; Remote; USD 192,000 - 356,000; Full time

Job summary

HCSC is seeking a physician reviewer to contribute to medical policies and programs while working remotely from home. The role involves performing medical reviews and engaging with provider communities across assigned areas.

Candidates must hold an unrestricted MD or DO license in the United States, maintain board certification, and have at least five years of clinical experience, with strong analytical, communication, and strategic thinking skills.

Qualifications

• Must hold a current and unrestricted MD or DO license in the United States.
• Board certification maintained by a recognized specialty board.
• Minimum 5 years of clinical experience.
• Strong analytical and communication abilities.
• Strategic thinking skills and effective documentation practices.

Responsibilities

• Responsible for assigned aspects of medical policies and programs.
• Performs medical reviews and interacts with provider communities in assigned areas.

Skills

Analytical skills

Communication skills

Strategic thinking

Clinical experience

Education

MD/DO (medical degree)

Tools

Microsoft 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

#LI-MG1

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. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards