Medical Director, Utilization Review (TX Licensed)

Job Summary

A company is looking for a Medical Director, Utilization Review.

Key Responsibilities:

• Perform comprehensive medical necessity reviews for various healthcare services using clinical expertise and established guidelines
• Conduct prior authorization reviews in alignment with clinical criteria and regulatory requirements
• Lead peer-to-peer discussions with practitioners to provide clinical rationales and facilitate open dialogue

Qualifications:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school
• Board Certification in a medical specialty
• Active and unrestricted Medical License in at least one US state
• Minimum of 5 years of clinical practice experience and 2-3 years in utilization management
• Strong analytical skills and understanding of medical necessity criteria and healthcare utilization management principles