Medical Director - Texas Licensed

Job Summary

To support clinical operations, the remote Medical Director - Texas Licensed will conduct coverage reviews, document clinical findings, and engage with providers to ensure effective benefit determinations while collaborating with a multidisciplinary team.

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
• Engage in peer-to-peer discussions with requesting providers as needed

Required qualifications:

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board certification in an ABMS specialty, preferably in Internal Medicine or Family Medicine
• 3+ years of clinical practice experience post-residency training
• Demonstrated understanding of Evidence Based Medicine (EBM)
• Proficient in MS Word, Outlook, and Excel