Medical Director - Clinical Advocacy

Job Summary

A company is looking for a Medical Director - Clinical Advocacy and Support with a preference for ENT or Internal Medicine.

Key Responsibilities

• Conduct coverage reviews and render coverage determinations based on member plan benefits
• Document clinical review findings in accordance with policies and regulatory requirements
• Engage in peer-to-peer discussions with requesting providers and collaborate with network and non-network providers

Required Qualifications

• M.D. or D.O. degree
• Active unrestricted license to practice medicine
• Board certification in an ABMS specialty, preferably in Internal Medicine, ENT, Hematology-Oncology, General Surgery, Rheumatology, or PM&R
• 3+ years of clinical practice experience post-residency
• Demonstrated understanding of Evidence Based Medicine (EBM)