Medical Director Utilization Management

Job Summary

A company is looking for a Medical Director Utilization Management - Remote.

Key Responsibilities

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

Required Qualifications

• M.D. or D.O. degree
• Active board certification in an ABMS or AOBMS specialty
• Active unrestricted medical license with the ability to obtain additional state licenses
• 5+ years of clinical practice experience post-residency
• Sound understanding of Evidence Based Medicine (EBM)