Remote Appeals MD: Quality & Compliance Leader

Ladders; United States; Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase options

401(k) contribution

Flexible remote work

Job summary

Ladders, on behalf of a leading healthcare organization, seeks an Appeals M.D. - FM or ER to lead remote reviews of appeals and grievances, ensure clinical soundness and regulatory compliance across multiple health plans.

The role partners with medical directors and regional leaders, contributes to process improvement, staff development, and committee work, and involves strong data analysis, telephonic communication, and strategic clinical oversight to improve access and outcomes.

Qualifications

• MD or DO with active/unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.
• Intermediate proficiency with managed care.
• Strong telephonic and interpersonal communication skills.
• Excellent project management and data analysis skills.
• Creative problem-solving abilities.
• Solid team player with team-building skills.

Responsibilities

• Perform individual case reviews for appeals and grievances across various health plans.
• Respond to regulatory inquiries from the Department of Insurance and CMS.
• Communicate appeals decision rationales with medical directors.
• Engage with regional medical directors on access and quality issues.
• Participate in team meetings for process improvement and staff training.
• Provide clinical input on organizational committees and projects.

Skills

Clinical license

Board certification

Quality management

Managed care

Communication skills

Project management

Data analysis

Problem solving

Team player

Education

MD/DO degree

Job description

Ladders, on behalf of a leading healthcare organization, seeks an Appeals M.D. - FM or ER to lead remote reviews of appeals and grievances, ensure clinical soundness and regulatory compliance across multiple health plans.

The role partners with medical directors and regional leaders, contributes to process improvement, staff development, and committee work, and involves strong data analysis, telephonic communication, and strategic clinical oversight to improve access and outcomes.