State Licensed Medical Director

Job Summary

Providing medical and leadership expertise, the full-time State Licensed Medical Director will oversee a team of medical directors, manage complex utilization management cases, and support strategic clinical initiatives in a remote capacity.

Key responsibilities

• Provide operational leadership and mentorship for front-line medical directors, including performance goal development and annual evaluations
• Participate in utilization review studies and manage the appeals process to ensure compliance with regulatory requirements
• Collaborate with clinical teams and network providers to ensure adherence to utilization management clinical coverage criteria

Required qualifications

• Medical Doctor (MD) degree from an accredited medical school
• 5+ years of managed care or clinical experience, with knowledge of commercial, Medicare, and Medicaid lines of business
• 1+ years of supervisory or management experience preferred
• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association
• Current state license as an MD or DO without restrictions, limitations, or sanctions