Texas Licensed Medical Director

Job Summary

A company is looking for a Medical Claims Review Medical Director - Remote.

Key Responsibilities

• Conduct coverage reviews based on member plan benefits and render coverage determinations
• Document clinical review findings and outcomes in accordance with policies and regulatory requirements
• Engage with providers in peer-to-peer discussions and collaborate on benefit determinations

Required Qualifications

• M.D. or D.O. degree
• Active unrestricted medical license
• Board certification in Family Medicine, Internal Medicine, or Emergency Medicine
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)