Texas Licensed Medical Director

Job Summary

To support clinical operations, the remote Texas Licensed Medical Director in Pediatrics/Internal Medicine or Family Medicine will conduct coverage reviews, document clinical findings, and collaborate with providers to ensure quality medical care and benefit determinations 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 educate them on benefit plans and medical policies

Required qualifications:

• M.D. or D.O. degree
• Board certification in Internal Medicine and Pediatrics OR Family Medicine
• 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)