Medical Director - California Licensed

Job Summary

To support clinical operations, the remote Medical Director - California Licensed will conduct coverage reviews, document clinical findings, and engage in peer discussions, while collaborating with providers to ensure cost-effective quality care for members.

Key responsibilities:

• Conduct coverage reviews based on member plan benefits and national policies, rendering coverage determinations
• Document clinical review findings and actions in compliance with policies and regulatory requirements
• Engage with providers in peer-to-peer discussions and communicate benefit determinations effectively

Required qualifications:

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board certification in an ABMS specialty, preferably Internal Medicine or Family Medicine
• 3+ years of clinical practice experience post-residency
• Demonstrated understanding of Evidence-Based Medicine (EBM)
• Proficient in MS Word, Outlook, and Excel