Colorado Licensed Medical Director

Job Summary

To support healthcare value initiatives, the part-time Colorado Licensed Medical Director will lead medical management processes, conduct coverage reviews, and collaborate with providers to ensure optimal care for members while working remotely.

Key responsibilities:

• Conduct coverage reviews and render determinations based on member plans and guidelines
• Communicate with providers to ensure accurate benefit determinations and educate them on medical policies
• Analyze utilization data to identify trends and collaborate on process improvements in medical treatment

Required qualifications:

• 10+ years of medical experience
• Active/unrestricted Medical License
• Active Board Certification in an ABMS/AOBMS specialty
• Comprehensive knowledge of medical management principles and insurance products
• Solid understanding of managed care systems and quality improvement processes