State Licensed Medical Director

Job Summary

To support the Medical Management team, the remote contract Medical Director Associate will conduct clinical case reviews, engage in peer-to-peer discussions, and apply evidence-based medical policies for post-acute care services.

Key Responsibilities

• Perform timely and accurate clinical case reviews for post-acute care services, including skilled nursing facilities and home health
• Conduct physician-to-physician discussions to gather clinical information and communicate medical-necessity determinations
• Document all determinations and collaborate with interdisciplinary teams to ensure efficient case processing

Required Qualifications

• MD or DO degree with an active, unrestricted U.S. medical license
• Board certification by ABMS or AOA (as applicable to specialty)
• Minimum of 3 years of clinical experience in inpatient or post-acute care settings
• At least 1 year of experience conducting medical-necessity reviews in a utilization management setting
• Demonstrated ability to apply clinical criteria and guidelines in decision-making