Remote Appeals Medical Director — Lead Quality & Access

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

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase options

401(k) contribution

Flexible remote work options

Job summary

Ladders is seeking an Appeals Medical Director to lead clinical reviews of appeals and grievances across health plans. This remote role partners with medical directors, network management, and operations to ensure decisions are medically sound, compliant, and well-documented.

The position drives process improvements, staff education, and committee work to improve access, quality, and regulatory outcomes. Requires MD/DO, board certification, and extensive clinical and quality management

Qualifications

• MD or DO with an active, unrestricted license.
• Board certification in an ABMS or AOBMS specialty.
• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.
• Intermediate proficiency in managed care.
• Excellent telephonic and interpersonal communication skills.
• Strong project management and data analysis 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 network management 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 leadership

Quality management

Project management

Data analysis

Communication skills

Managed care knowledge

Education

MD or DO degree

Board Certified in ABMS/AOBMS

Job description

Ladders is seeking an Appeals Medical Director to lead clinical reviews of appeals and grievances across health plans. This remote role partners with medical directors, network management, and operations to ensure decisions are medically sound, compliant, and well-documented.

The position drives process improvements, staff education, and committee work to improve access, quality, and regulatory outcomes. Requires MD/DO, board certification, and extensive clinical and quality management