Massachusetts Licensed Medical Director

Job Summary

To support clinical operations, the part-time Massachusetts Licensed Medical Director will conduct coverage reviews, document clinical findings, and engage in peer discussions while working remotely from anywhere within the U.S.

Key responsibilities

• Conduct coverage reviews based on individual member plan benefits and national policies, rendering coverage determinations
• Document clinical review findings, actions, and outcomes in accordance with policies and regulatory requirements
• Communicate and collaborate with network and non-network providers to ensure accurate and timely benefit determinations

Required qualifications

• M.D. or D.O. degree
• Board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• Active unrestricted license to practice medicine
• 5+ years of clinical practice experience post-residency
• Sound understanding of Evidence Based Medicine (EBM)