Medical Director with State License

A company is looking for a Medical Director to oversee health claims and ensure regulatory compliance. Key Responsibilities Provide medical interpretation and determinations for service authorizations based on national guidelines and CMS requirements Conduct computer-based reviews of clinical scenarios and communicate decisions to internal associates Engage with external physicians and support regional market priorities related to healthcare services Required Qualifications MD or DO degree 5+ years of direct clinical patient care experience post-residency or fellowship Current and ongoing Board Certification in an approved ABMS Medical Specialty A current and unrestricted medical license in at least one jurisdiction No current sanction from Federal or State Governmental organizations

Mar 5, 2025 - 20:33

A company is looking for a Medical Director to oversee health claims and ensure regulatory compliance. Key Responsibilities Provide medical interpretation and determinations for service authorizations based on national guidelines and CMS requirements Conduct computer-based reviews of clinical scenarios and communicate decisions to internal associates Engage with external physicians and support regional market priorities related to healthcare services Required Qualifications MD or DO degree 5+ years of direct clinical patient care experience post-residency or fellowship Current and ongoing Board Certification in an approved ABMS Medical Specialty A current and unrestricted medical license in at least one jurisdiction No current sanction from Federal or State Governmental organizations