Texas Licensed Medical Director

Job Summary

To support clinical operations, the part-time Texas Licensed Medical Director will conduct coverage reviews, document clinical findings, and engage with providers remotely while ensuring cost-effective quality medical care for members.

Key responsibilities

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

Required qualifications

• M.D. or D.O
• Board certification in Internal Medicine and Pediatrics through ABMS or AOA
• Active unrestricted medical license with the ability to obtain additional state licenses
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)