Remote Medical Director, Appeals

Ladders; United States; Remote; USD 215,000 - 409,000; Full time

Benefits offered by this job

Comprehensive health insurance

401K and stock purchase plans

Tuition reimbursement

Generous paid time off

Flexible work arrangements (remote/hyb

Job summary

Ladders seeks a Remote Medical Director - Appeals to lead medical oversight of utilization management, quality improvement, and appeals processes. The role involves reviewing complex cases, guiding medical necessity decisions, and partnering with care teams to support timely, compliant outcomes.

The position emphasizes regulatory compliance, performance improvement, and serving diverse populations, with remote work options and US-based eligibility.

Qualifications

• MD or DO required.
• Experience in Utilization Management and knowledge of quality accreditation standards preferred.
• Active medical practice is essential.
• Coursework in Health Administration, Health Financing, Insurance, or Personnel Management is advantageous.
• Experience with culturally diverse populations is preferred.
• Board certification in a recognized medical specialty is required.
• Current, unrestricted state medical license (MD or DO) is mandatory.

Responsibilities

• Provide medical leadership for utilization management and quality improvement activities
• Conduct medical reviews for complex and controversial services to support timely decision‑making
• Support performance improvement initiatives for capitated providers
• Assist in planning and establishing goals to enhance care quality and cost-effectiveness
• Provide medical expertise for quality improvement and utilization management programs in compliance with regulations
• Conduct regular rounds to assess high-risk patients and collaborate with care management teams
• Collaborate with clinical teams and providers on complex cases and medical necessity appeals

Skills

Active medical license

Board certification

Utilization management experience

Quality improvement knowledge

Cultural competence

Healthcare regulations knowledge

Medical reviews

Education

MD or DO

Board certification in medical specialty

State medical license

Health Administration coursework advantageous

Job description

For our client, we are seeking a Remote Medical Director, Appeals to join the team of a leader in the Hospitals & Medical Centers space.

This role provides medical leadership across utilization management, quality improvement, and appeals processing in a highly regulated healthcare environment. The physician will review complex cases, guide medical necessity decisions, and partner closely with clinical teams and care management to support timely, compliant outcomes. The position also helps shape performance improvement efforts, with a focus on quality, cost-effectiveness, and care for diverse populations.

Location: Remote - US based candidates only, no visa sponsorship available

Compensation: $215,000 – $408,500 annually

Responsibilities

• Provide medical leadership for utilization management and quality improvement activities
• Conduct medical reviews for complex and controversial services to support timely decision‑making
• Support performance improvement initiatives for capitated providers
• Assist in planning and establishing goals to enhance care quality and cost-effectiveness
• Provide medical expertise for quality improvement and utilization management programs in compliance with regulations
• Conduct regular rounds to assess high-risk patients and collaborate with care management teams
• Collaborate with clinical teams and providers on complex cases and medical necessity appeals

Qualifications

• Medical Doctor (MD) or Doctor of Osteopathy (DO) required
• Experience in Utilization Management and knowledge of quality accreditation standards preferred
• Active medical practice is essential
• Coursework in Health Administration, Health Financing, Insurance, or Personnel Management is advantageous
• Experience with culturally diverse populations is preferred
• Board certification in a recognized medical specialty is required
• Current, unrestricted state medical license (MD or DO) is mandatory

Benefits

• Comprehensive health insurance coverage
• 401K and stock purchase plans available
• Tuition reimbursement for further education
• Generous paid time off plus holidays
• Flexible work arrangements including remote, hybrid, and office options

Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.