State Licensed Medical Director

Job Summary

A company is looking for a Medical Director (Medical Policy & Operations).

Key Responsibilities

• Provide clinical expertise and business direction for medical management programs
• Support the appeal process, clinical claim review, pre-certification, and predetermination of covered benefits
• Utilize data analysis to identify quality improvement opportunities in health care services

Required Qualifications

• Five (5) or more years of experience in Health Care Delivery System
• Active and current state medical license without encumbrances
• M.D. or D.O., Board Certification in an ABMS recognized specialty
• Post-graduate direct patient care experience