Medical Director - Texas Licensed

Job Summary

A company is looking for a Medical Claims Review Medical Director, Remote.

Key Responsibilities

• Conduct coverage reviews and render coverage determinations based on member plan benefits
• Document clinical review findings and engage in peer-to-peer discussions with providers as needed
• Collaborate with network and non-network providers to ensure accurate benefit determinations and educate on medical policies

Required Qualifications

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board certification approved by the AMBS or AOBMS specialty
• 5+ years of clinical practice experience after completing residency training
• Proven understanding of Evidence Based Medicine (EBM)
• Demonstrated proficiency in MS Word, Outlook, and Excel