Washington Licensed Assistant Medical Director

Job Summary

Providing benefit coverage determinations based on medical necessity, the full-time Washington Licensed Assistant Medical Director will support clinical review activities, engage in peer-to-peer discussions with external providers, and participate in the development of medical review criteria while working remotely with occasional Saturday shifts.

Key responsibilities

• Support clinical review activities including pre-service, post-service, and concurrent facility-based care decisions
• Utilize clinical expertise to assist in claims review decisions and support care options for members enrolled in clinical programs
• Participate in the development and approval of medical review criteria as a member of the Medical Policy Committee

Required qualifications

• Physicians license with an MD or DO degree
• Unrestricted Washington state licensure or ability to obtain within 90 days
• Five (5) years of clinical experience
• Current board certification from a recognized medical association (preferred)
• Previous experience in medical necessity and clinical reviews in a health plan setting (preferred)