Texas Licensed Medical Director

Job Summary

To support clinical operations, the remote Texas Licensed Medical Director in Pediatrics and Internal Medicine will manage coverage reviews, collaborate with providers for benefit determinations, and document clinical findings while ensuring cost-effective quality care for members.

Key responsibilities

• Conduct coverage reviews based on individual member plan benefits and render coverage determinations
• Document clinical review findings and engage in peer-to-peer discussions with requesting providers
• 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 as needed
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)