Medical Director - Claims Management

A company is looking for a Medical Director in Claims Management. Key Responsibilities Make determinations on service authorizations at the Appeals/Disputes level based on clinical guidelines and regulatory compliance Conduct computer-based reviews of clinical scenarios and communicate decisions to internal associates Engage with external physicians and healthcare providers to support regional market priorities and collaborative business relationships Required Qualifications MD or DO degree 5+ years of direct clinical patient care experience post residency or fellowship, preferably in an inpatient environment Current and ongoing Board Certification in an approved ABMS Medical Specialty A current and unrestricted medical license in at least one jurisdiction No current sanctions from Federal or State Governmental organizations

Mar 21, 2025 - 20:30

A company is looking for a Medical Director in Claims Management. Key Responsibilities Make determinations on service authorizations at the Appeals/Disputes level based on clinical guidelines and regulatory compliance Conduct computer-based reviews of clinical scenarios and communicate decisions to internal associates Engage with external physicians and healthcare providers to support regional market priorities and collaborative business relationships Required Qualifications MD or DO degree 5+ years of direct clinical patient care experience post residency or fellowship, preferably in an inpatient environment Current and ongoing Board Certification in an approved ABMS Medical Specialty A current and unrestricted medical license in at least one jurisdiction No current sanctions from Federal or State Governmental organizations