State Licensed Medical Director

Job Summary

Providing clinical expertise and strategic guidance, the fully remote State Licensed Medical Director will oversee medical management functions, support complex clinical decision-making, and drive innovation in medical review processes.

Key Responsibilities

• Provides clinical oversight and governance for the medical review program, including appeals and grievance processes
• Conducts comprehensive clinical reviews for first and second-level appeals, ensuring compliance with policy provisions and regulatory requirements
• Partners with legal and cross-functional teams to align on clinical evaluations and improve medical management processes

Required Qualifications

• MD or DO degree with an active and unrestricted license to practice medicine
• Minimum of 8 years of relevant clinical experience
• Experience in health insurance preferred
• Strong background in clinical decision support and regulatory compliance
• Proficient in MS Word, PowerPoint, and Excel