State Licensed Medical Director

Job Summary

To enhance the utilization management program, the full-time State Licensed Medical Director will perform clinical reviews, mentor clinical teams, and analyze utilization data, working remotely to ensure quality and evidence-based guidelines are followed.

Key responsibilities

• Assist in developing and maintaining an efficient utilization management program tailored to health plan members' needs
• Conduct clinical reviews and peer discussions, while participating in inter-rater reliability activities
• Provide clinical support and serve as a subject matter expert for both clinical and non-clinical staff

Required qualifications

• Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required
• Five or more years of clinical practice experience
• Three years of previous medical director experience in utilization management or medical management