Medical Director - Clinical Advocacy

Job Summary

Providing physician support for clinical operations, the remote Medical Director - Clinical Advocacy will conduct coverage reviews, document clinical findings, and engage with providers to ensure quality medical care and cost-effective service delivery.

Key responsibilities:

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

Required qualifications:

• M.D. or D.O. with an active unrestricted license to practice medicine
• Active board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association, preferably in surgery specialties
• 3+ years of clinical practice experience after completing residency training
• Demonstrated understanding of Evidence Based Medicine (EBM)
• Proficient in MS Word, Outlook, and Excel