Job Summary
A company is looking for a Medical Director - Clinical Advocacy and Support.
Key Responsibilities
- Conduct coverage reviews and render coverage determinations based on member plan benefits
- Document clinical review findings and engage in peer-to-peer discussions with providers
- Collaborate with network and non-network providers to ensure accurate benefit determinations
Required Qualifications
- M.D. or D.O. with an active unrestricted license to practice medicine
- Board certification in an ABMS specialty preferred (e.g., Internal Medicine, Family Medicine)
- 3+ years of clinical practice experience post-residency
- Demonstrated understanding of Evidence Based Medicine (EBM)
- Proficient in MS Word, Outlook, and Excel
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