Washington Licensed Assistant Medical Director

Job Summary

A company is looking for an Assistant Medical Director.

Key Responsibilities

• Support clinical review activities, making final coverage decisions based on medical necessity and contractual exclusions
• Utilize clinical expertise for claims review decisions, including level of care and payment determinations
• Consult with clinical staff and participate in the development of medical review criteria and ongoing education for clinicians

Required Qualifications

• MD or DO degree with an unrestricted Washington state license or ability to obtain one within 90 days
• Five (5) years of clinical experience
• Current board certification from a recognized medical specialty board (preferred)
• Previous experience in medical necessity and clinical reviews within a health plan setting (preferred)
• Familiarity with clinical criteria sets and coding concepts (preferred)