State Licensed Medical Director

Job Summary

Providing clinical leadership and medical oversight for audit programs, the remote State Licensed Medical Director will manage audit strategy, clinical review methodologies, and ensure compliance with payer policies while supporting governmental and commercial payer programs.

Key Responsibilities:

• Provide clinical leadership and oversight for audit programs involving governmental and commercial payer claims
• Review and interpret medical records, claims data, and payer policies to support accurate audit determinations
• Evaluate medical necessity and alignment with applicable clinical standards and payer requirements

Required Qualifications:

• Medical degree (MD or DO) required
• Active, unrestricted medical license in good standing required
• Minimum of 5+ years of direct clinical patient care experience post-residency or fellowship required
• Experience with governmental payer programs, including Medicare and Medicaid, strongly preferred
• No current sanctions, exclusions, or restrictions from federal or state governmental healthcare programs