Medical Director - Oncology/Hematology

Job Summary

A company is looking for a Medical Claims Review Medical Director specializing in Hematology or Oncology for a remote position.

Key Responsibilities

• Conduct coverage reviews based on individual member plan benefits and render coverage determinations
• Document clinical review findings and engage with requesting providers in peer-to-peer discussions
• Communicate and collaborate with network and non-network providers to ensure accurate benefit determinations

Required Qualifications

• M.D. or D.O. degree
• Active unrestricted medical license and ability to obtain additional state licenses as needed
• Board certification in Oncology or Hematology
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)