Medical Director - Utilization Management

Job Summary

To support clinical operations, the remote Medical Director - Utilization Management will conduct coverage reviews, document clinical findings, and engage with providers to ensure appropriate and cost-effective medical care for members.

Key responsibilities

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

Required qualifications

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board Certified through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA), preferably in Internal or Family Medicine
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)
• PC skills, specifically using MS Word, Outlook, and Excel