Medical Director - Texas Licensed

Job Summary

A company is looking for a Medical Director Utilization Management - Remote.

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 ensure accurate benefit determinations

Required Qualifications

• M.D. or D.O. degree
• Active board certification in an ABMS or AOBMS specialty
• Active unrestricted medical license and ability to obtain additional state medical licenses
• 5+ years of clinical practice experience after completing residency training
• Proven understanding of Evidence Based Medicine (EBM)