New York Licensed Medical Director

Job Summary

A company is looking for a Medical Director - Clinical Advocacy and Support.

Key Responsibilities

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

Required Qualifications

• M.D. or D.O. with an active unrestricted license to practice medicine
• Board certification in an ABMS specialty, preferably in Internal Medicine, Family Medicine, Hematology, General Surgery, Rheumatology, or PM&R
• 3+ years of clinical practice experience after residency training
• Demonstrated understanding of Evidence Based Medicine (EBM)
• Proven solid PC skills, specifically in MS Word, Outlook, and Excel