Surgical Specialty Medical Director

Job Summary

To support clinical operations, the remote Surgical Specialty Medical Director will manage coverage reviews, collaborate with multidisciplinary teams on benefit determinations, and ensure quality medical care for members while working full-time in a salaried position.

Key responsibilities

• Conduct coverage reviews based on individual member plan benefits and render coverage determinations
• Document clinical review findings and engage with providers in peer-to-peer discussions as needed
• Communicate and collaborate with network and non-network providers to ensure accurate and timely benefit determinations

Required qualifications

• M.D. or D.O
• Board certification in any surgical specialty through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• Active unrestricted medical license and ability to obtain additional state medical licenses as needed
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)