Medical Director – Appeals

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $191.5k - $355.6k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Handle assigned aspects of medical policies and programs • Perform medical reviews • Interact with provider communities for assigned areas • Conduct electronic documentation of case reviews

🎯 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 Microsoft Office and Lotus Notes, for electronic documentation of case reviews • 3 years of Managed Care experience preferred • Cardiology, Gastroenterology, Rheumatology, Dermatology, Hematology, Oncology, or internal medicine specialty preferred but not required

🏖️ Benefits

• Curated development plans fostering growth and rewarding careers • 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 • Other incentives • Annual incentive bonus plan subject to plan terms and conditions