Medical Director - California Licensed

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 in accordance with policies and regulatory requirements
• Engage with providers in peer-to-peer discussions and collaborate with internal partners for 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
• 3+ years of clinical practice experience after residency training
• Demonstrated understanding of Evidence Based Medicine (EBM)
• Proven proficiency in MS Word, Outlook, and Excel