State Licensed Field Medical Director

Job Summary

To support the utilization management team, the full-time State Licensed Field Medical Director in MSK Surgery will review Hip/Knee/Shoulder Surgery cases, engage in peer-to-peer discussions with physicians, and ensure compliance with medical necessity guidelines while working remotely.

Key responsibilities

• Serve as the Physician match reviewer for surgical cases and imaging requests that require specialty reviews
• Discuss determinations with requesting physicians and provide clinical rationale for appeals within regulatory timeframes
• Utilize medical review guidelines to ensure consistent compliance with policies and accreditation standards

Required qualifications

• MD/DO/MBBS with active Board Certification in Orthopedic Surgery
• Minimum of five years' experience in medicine, with active clinical practice within the last two years preferred
• Current, unrestricted clinical license in medicine or required specialty
• Strong clinical, management, communication, and organizational skills
• No history of major disciplinary action by a state medical board or exclusion from federal health care programs