Texas Licensed Medical Director

Job Summary

To support a growing healthcare organization, the full-time Texas Licensed Medical Director will oversee utilization reviews, conduct prior authorizations, and make medical necessity determinations in a remote environment.

Key Responsibilities

• Perform comprehensive medical necessity reviews for various healthcare services, applying clinical expertise and evidence-based guidelines
• Conduct prior authorization reviews to ensure compliance with clinical criteria and regulatory requirements
• Lead peer-to-peer discussions with practitioners, providing clinical rationales and facilitating open dialogue

Required Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school
• Board Certification in Psychiatry
• Active and unrestricted Medical License in at least one state
• Minimum of 5 years of clinical practice experience
• 2-3 years of experience in utilization management or prior authorizations within an insurance or managed care organization