Medical Director (Appeals)

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. Job Summary 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 Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii. 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. Base Pay Range $191,500.00 - $355,600.00Exact compensation may vary based on skills, experience, and location. Originally posted on Himalayas