North Carolina Licensed Medical Director

Job Summary

Leading a team of clinical professionals, the full-time remote North Carolina Licensed Medical Director will provide support for self-funded clients, focusing on medical policy development, clinical oversight, and cost-effective resolution of member claims.

Key responsibilities

• Create and update medical policies and procedures to ensure compliance with medical standards
• Provide clinical support across all areas of Clinical Services, including coverage and medical necessity determinations
• Advise nursing staff on care appropriateness and support training to enhance their knowledge and independence

Required qualifications

• Board certification in Internal Medicine or Pediatrics, or a subspecialty
• Minimum of 3 years' experience in a managed care environment focused on utilization management
• 3+ years of clinical practice in an office or hospital setting
• Current, unrestricted clinical license(s) in North Carolina
• Knowledge of evidence-based medical guidelines and medical management functions