Medical Director with State License

Job Summary

To ensure the highest clinical standards in utilization management, the full-time remote Medical Director with State License will conduct electronic reviews of cases, manage medical necessity determinations, and participate in multidisciplinary team discussions.

Key responsibilities

• Conduct electronic reviews of escalated cases to determine medical necessity and appropriateness
• Complete initial determinations, reviews of appeals, and compose rationales for member notifications
• Participate in protocol development and manage projects requiring physician expertise

Required qualifications

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
• Board Certification in a recognized specialty
• Active medical state licensure in PA, NY, or WV
• 5 years of clinical direct patient care experience
• Strong background in medical management and familiarity with compliance standards