Internal Medicine Medical Director

Job Summary

To support clinical operations, the remote Medical Claims Review Medical Director in Internal Medicine will conduct coverage reviews, document clinical findings, and engage in peer-to-peer discussions while ensuring cost-effective quality care for members.

Key responsibilities

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

Required qualifications

• M.D. or D.O. with an active unrestricted medical license
• Current board certification in Internal Medicine through ABMS or AOA
• 5+ years of clinical practice experience after completing residency training
• Proven understanding of Evidence Based Medicine (EBM)
• Demonstrated proficiency in MS Word, Outlook, and Excel