Medical Director -Pharmacy Appeals

Candidates must possess an MD or DO degree and have at least 5 years of direct clinical patient care experience post residency or fellowship, preferably with exposure to a Medicare-eligible population. A current and ongoing Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Physical Medicine and Rehabilitation is required, along with a current and unrestricted medical license in at least one jurisdiction. Candidates must not have any current sanctions from Federal or State Governmental organizations and must be able to pass credentialing requirements. Excellent verbal and written communication skills, along with demonstrated analytic and interpretation skills from prior experience in quality management, utilization management, or similar activities, are also necessary. Preferred qualifications include knowledge of the managed care industry, utilization management experience in a medical management review organization, familiarity with national guidelines, and exposure to public health or population health analytics.