State Licensed Plastic Surgeon 3093012 I.Html
Job Description
To support clinical operations, a State Licensed Plastic Surgeon will work remotely to manage the review and adjudication of appeals and grievances cases, ensuring compliance with medical policies and regulatory standards.
##### Key responsibilities
Perform individual case reviews for appeals and grievances related to various health plan products
Communicate with medical directors regarding appeals decision rationales and benefit interpretations
Participate in team meetings focused on process improvement, staff training, and organizational projects
##### Required qualifications
MD or DO with an active, unrestricted license
Board Certified in an ABMS or AOBMS specialty
5+ years of clinical practice experience
2+ years of Quality Management experience
Familiarity with current medical issues and practices
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