California Licensed Medical Director

Job Summary

California Licensed Medical Director, responsible for providing physician support in clinical operations, conducting coverage reviews, and collaborating with healthcare providers, in a full-time remote position.

Key Responsibilities

• Conduct coverage reviews based on member plan benefits and render coverage determinations
• Document clinical review findings and engage in peer-to-peer discussions with providers
• Communicate and collaborate with network and non-network providers for accurate benefit determinations

Required Qualifications

• M.D. or D.O. degree
• Board certification in General Surgery
• Active unrestricted medical license
• 5+ years of clinical practice experience post-residency
• Sound understanding of Evidence Based Medicine (EBM)