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 while ensuring cost-effective quality medical care for members.

Key responsibilities

• Conduct coverage reviews based on individual member plan benefits and national coverage review policies
• Document clinical review findings and communicate with network and non-network providers for accurate benefit determinations
• Engage in peer-to-peer discussions with requesting providers as needed

Required qualifications

• M.D. or D.O. with board certification in General Surgery and experience in Vascular Surgery
• Active unrestricted license to practice medicine in California
• 5+ years of clinical practice experience post-residency
• Sound understanding of Evidence Based Medicine (EBM) and experience performing vascular surgeries
• Ability and willingness to participate in call coverage rotation