California Licensed Medical Director

Job Summary

To support clinical operations, the part-time California Licensed Medical Director will conduct coverage reviews, document findings, and engage with providers remotely, ensuring quality medical care and cost-effective benefit determinations for members.

Key responsibilities:

• Conduct coverage reviews based on individual member plan benefits and national policies, rendering coverage determinations
• Document clinical review findings and actions in accordance with policies and regulatory requirements
• Engage in peer-to-peer discussions with requesting providers as needed

Required qualifications:

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board certification in an ABMS specialty, preferably Internal Medicine or Family Medicine
• 3+ years of clinical practice experience post-residency
• Sound understanding of Evidence Based Medicine (EBM)
• Proficient in MS Word, Outlook, and Excel