Medical Director - Georgia Licensed

Job Summary

To support clinical operations, the remote Medical Director - Georgia Licensed will conduct coverage reviews, document clinical findings, and engage with providers to ensure effective benefit determinations while working full-time in a collaborative environment.

Key responsibilities:

• Conduct coverage reviews based on member plan benefits and render coverage determinations
• Document clinical review findings 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 medical license
• Current board certification in Internal Medicine through ABMS or AOA
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)
• Demonstrated proficiency in MS Word, Outlook, and Excel