State Licensed Medical Director

Job Summary

To support healthcare facilities, the full-time State Licensed Medical Director will serve as a clinical resource, managing peer-to-peer consultations, educating physicians on documentation practices, and facilitating payer approvals while working remotely.

Key responsibilities

• Conduct peer-to-peer reviews with health plan counterparts for denied inpatient cases
• Educate physicians on ICD coding guidelines and clinical terminology to improve documentation accuracy
• Analyze utilization review metrics and collaborate with hospital committees to develop denial reduction strategies

Required qualifications

• Licensed (or eligible for licensure) Physician (MD/DO) in a U.S. state
• Board Certification required, preferably in Internal Medicine or Family Medicine
• Minimum of 5 years of clinical practice experience
• Knowledge of InterQual, Milliman, or similar evidence-based criteria sets
• Familiarity with Joint Commission, State and Federal standards, and reimbursement models