Massachusetts Licensed Medical Director

Job Summary

To support clinical operations, the part-time Massachusetts Licensed Medical Director will conduct coverage reviews, collaborate with healthcare providers, and ensure quality medical care for members while working remotely across the U.S.

Key responsibilities

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

Required qualifications

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board certified through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• 5+ years of clinical practice experience after completing residency training
• Proven understanding of Evidence Based Medicine (EBM)
• Ability to participate in rotational holiday and call coverage