Plastic Surgery Medical Director

Job Summary

A company is looking for a Medical Claims Review Medical Director specializing in Plastic Surgery, working remotely.

Key Responsibilities

• Conduct coverage reviews and render coverage determinations based on member plan benefits
• Document clinical review findings in accordance with policies and regulatory requirements
• Engage in peer-to-peer discussions with requesting providers and collaborate with network and non-network providers

Required Qualifications

• M.D. or D.O. degree
• Active unrestricted license to practice medicine
• Board certification in Plastic Surgery
• 5+ years of clinical practice experience post-residency
• Sound understanding of Evidence Based Medicine (EBM)