Massachusetts Licensed Medical Director

Job Summary

A company is looking for a Medical Director, Clinical Reviews.

Key Responsibilities

• Perform clinical reviews for utilization management, including prospective, concurrent, and retrospective coverage requests
• Communicate with providers and facilities to resolve clinical issues and support the provider inquiry process
• Conduct quality of care reviews and assist with credentialing reviews for providers and facilities

Required Qualifications

• Current unrestricted license as a medical or osteopathic doctor
• Board-Certified MD or DO in a specialty recognized by the American Board of Medical Specialties
• Minimum of five years of clinical experience
• Experience in utilization management or quality management preferred
• Ability to perform utilization management activities in accordance with accreditation standards