Medical Director - California Licensed
Job Summary
To support clinical operations, the full-time Medical Director - California Licensed will conduct coverage reviews, document clinical findings, and engage with providers remotely while focusing on improving health outcomes and managing medical benefits.
Key responsibilities
- Conduct coverage reviews based on individual member plan benefits and national policies, rendering coverage determinations
- Document clinical review findings and actions in accordance with policies and regulatory requirements
- Engage in peer-to-peer discussions with requesting providers as needed
Required qualifications
- M.D. or D.O. with an active unrestricted license to practice medicine
- Board certification in an ABMS specialty, preferably in Internal Medicine or Family Medicine
- 3+ years of clinical practice experience post-residency training
- Demonstrated understanding of Evidence Based Medicine (EBM)
- Proficient in MS Word, Outlook, and Excel
Complete Job Description
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