Medical Director with State License

Job Summary

Providing executive physician leadership for medical review operations, the full-time salaried Medical Director with State License will oversee physician reviewers, ensure regulatory compliance, and drive continuous quality improvement initiatives in a remote setting.

Key responsibilities

• Lead and mentor a team of physician reviewers to ensure accurate and evidence-based clinical decisions
• Develop quality assurance processes that promote continuous improvement across medical review activities
• Evaluate clinical trends and operational metrics to identify opportunities for process optimization

Required qualifications

• Graduate of an accredited Medical School with an active, unrestricted medical license in good standing
• Current Board Certification in a recognized specialty
• Minimum 10 years of clinical practice experience and at least 5 years in physician leadership or medical management
• Experience with Medicare Advantage/Part C and recent hands-on patient care within the past three years
• Strong knowledge of Medicare Advantage regulations and demonstrated ability to interpret healthcare regulations