Utilization Management Medical Director- Remote

Responsibilities

• Conduct coverage reviews using member plan benefits and coverage review policies
• Document clinical review findings in accordance with regulatory guidelines
• Engage in peer-to-peer discussions with requesting providers
• Interpret benefit language during clinical coverage reviews
• Participate in daily clinical rounds as needed
• Educate providers on benefit plans and medical policies
• Collaborate with internal partners to ensure accurate benefit determinations

Qualifications

• M.D. or D.O. required
• Board certification from ABMS or AOA
• Active unrestricted medical license
• 5+ years of clinical practice experience post-residency
• Strong knowledge of evidence-based medicine
• Proficiency in MS Word, Outlook, and Excel
• Willingness to participate in holiday and call coverage

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase option
• 401(k) contribution with eligibility requirements
• Flexibility to work remotely from anywhere in the U.S.