State Licensed Medical Director

Job Summary

To support clinical operations, the remote State Licensed Medical Director will manage coverage reviews, document clinical findings, and engage with providers to ensure appropriate and cost-effective medical care for members.

Key responsibilities:

• Conduct coverage reviews based on individual member plan benefits and render coverage determinations
• Document clinical review findings in accordance with policies, regulatory, and accreditation requirements
• Communicate and collaborate with network and non-network providers to ensure accurate benefit determinations

Required qualifications:

• M.D. or D.O
• Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• Active unrestricted license to practice medicine
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)