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 with providers in peer-to-peer discussions
- Communicate and collaborate with network and non-network providers 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
- 5+ years of clinical practice experience post-residency
- Sound understanding of Evidence Based Medicine (EBM)
- Ability to participate in call coverage rotation
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