Remote Medical Director, Appeals

About This Opportunity

Our talent team at Get A Job.ai is representing a confidential healthcare organization seeking a Remote Medical Director, Appeals based in Macao. This leadership role focuses on medical management, utilization review, and appeals oversight within a managed care environment.

You'll provide clinical expertise in complex medical necessity determinations, collaborate with care management teams on high-risk patient coordination, and support quality improvement initiatives that impact member outcomes. This position reports to senior medical leadership and requires active medical practice alongside administrative responsibilities.

Responsibilities

• Direct medical management, quality improvement, and utilization review functions for the business unit
• Perform medical reviews of complex, controversial, or experimental medical services with timely decision-making
• Collaborate with appeals teams, network providers, and medical consultants on medical necessity cases
• Conduct rounds to assess high-risk patients and coordinate with care management teams
• Support performance improvement initiatives and cost-effectiveness programs
• Assist in physician committee structure, processes, and membership oversight
• Identify and evaluate utilization trends, provider practice patterns, and benefit adequacy
• Interface with physicians and providers to implement recommendations improving care quality
• Develop alliances with the provider community through medical management programs
• Represent the organization at state committees and industry forums as needed
• Weekend and holiday support may be required based on business operations

What We're Looking For

Required:

• Medical Doctor (MD) or Doctor of Osteopathy (DO)
• Board certification in a medical specialty recognized by ABMS or AOA
• Current unrestricted state medical license without sanctions from government programs
• Actively practicing medicine

Preferred:

• Utilization Management experience and knowledge of quality accreditation standards
• Board certification in Internal Medicine or Family Medicine
• Coursework in Health Administration, Health Financing, Insurance, or Personnel Management
• Experience treating or managing care for culturally diverse populations

How We Work with You

Candidates apply directly through Get A Job.ai. A member of our recruiting team will conduct an initial screening to understand your background and career goals. We then present qualified candidates to our client for consideration. Please do not contact the client organization directly—all communication flows through our team to ensure a professional, coordinated process.

Pay

Pay details will be discussed during the screening process based on the client's compensation structure and your qualifications.

Equal Employment Opportunity: Get A Job.ai is committed to diversity and inclusion. We consider all qualified applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.