Orthopedic Spine Surgeon Medical Director - Newark New Jersey

Company: VirtualVocations
Location: Newark, New Jersey
Posted On: 01/29/2025

A company is looking for an Appeals and Grievances Medical Director - Orthopedic or Neurological Spine Surgeon.



Key Responsibilities

Conduct clinical reviews and adjudications of appeals and grievances for various health plan products
Respond to regulatory inquiries from the Department of Insurance, Department of Managed Healthcare, and CMS
Collaborate with medical directors and network management on access, quality, and benefit interpretation issues


Required Qualifications

MD or DO with an active, unrestricted license
Board Certified Orthopedic or Neurological Spine Surgeon
5+ years of clinical practice experience
2+ years of Quality Management experience
Intermediate proficiency with managed care More...

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