Medical Director with State License

Job Summary

A company is looking for a Medical Director to oversee utilization management responsibilities in accordance with clinical standards.

Key Responsibilities

• Conduct electronic reviews of escalated cases to determine medical necessity and appropriateness
• Complete initial determinations, reviews of appeals, and compose rationales for notifications
• Participate in multidisciplinary team activities and assist in protocol development for consistency in reviews

Required Qualifications

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
• Board Certification in a specialty recognized by relevant medical boards
• Active medical state licensure for PA, NY, or WV
• 5 years of experience in clinical, direct patient care
• Experience in medical management within a health insurance plan is preferred