State Licensed Medical Director

Job Summary

Seeking a highly skilled State Licensed Medical Director in a full-time remote position, responsible for assessing the quality of clinical services for Medicare beneficiaries, ensuring compliance with guidelines, and driving improvements in care delivery through case reviews and peer discussions.

Key Responsibilities

• Conduct regular case reviews to monitor care appropriateness and recommend necessary adjustments to align with CMS guidelines
• Participate in peer-to-peer discussions with providers regarding clinical documentation and prior authorization requests
• Assist in training clinical teams on CMS guidelines and participate in quality improvement initiatives to enhance care delivery

Required Qualifications

• Board-certified clinician with a Doctor of Medicine or Doctor of Osteopathy, preferably in anesthesiology or related specialties
• At least 3 years of board certification experience
• Active, valid, and unrestricted medical license in at least one U.S. state, with a preference for Washington
• Utilization management experience is preferred
• Must not be excluded from Medicare, Medicaid, or CHIP participation