Texas Licensed Medical Director

Job Summary

A company is looking for a Medical Director, Utilization Review.

Key Responsibilities:

• Perform comprehensive medical necessity reviews for various healthcare services
• Conduct prior authorization reviews ensuring compliance with clinical criteria and regulations
• Lead peer-to-peer discussions with practitioners and issue medical necessity denials when warranted

Qualifications:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school
• Board Certification in a medical specialty
• Active and unrestricted Medical License in at least one US state
• Minimum of 5 years of clinical practice experience and 2-3 years in utilization management
• Proficiency with electronic health records (EHR) systems and utilization management software