Ohio Licensed Assistant Medical Director

Job Summary

Providing clinical expertise to enhance the delivery of high-quality, cost-effective medical care, the full-time Ohio Licensed Assistant Medical Director will support utilization review processes, conduct pre-determination reviews, and ensure compliance with clinical goals in a remote setting.

Key responsibilities

• Oversee the utilization review process and ensure appropriate medical care is received
• Conduct pre-determination reviews and provide clinical expertise for claims determinations
• Guide the case management team in coordinating quality care and monitor care management performance

Required qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school
• Minimum of 5 years of established clinical care practice experience
• Board Certification in a nationally recognized specialty (ABMS or AOA) is required
• Active unrestricted license to practice medicine in the state of residency
• Knowledge of health plan claims adjudication and utilization review processes preferred