State Licensed Medical Director

A company is looking for a Clinical Review Medical Director specializing in Cardiology or Neurology, with remote work options available.

Key Responsibilities

Conduct coverage reviews based on member plan benefits and national coverage policies, rendering coverage determinations

Document clinical review findings and actions in accordance with policies and regulatory requirements

Engage in peer-to-peer discussions with requesting providers and collaborate with internal partners for timely benefit determinations

Required Qualifications

M.D. or D.O. with an active unrestricted license to practice medicine

Board Certification in Cardiology or Neurology

5+ years of clinical practice experience post-residency

Sound understanding of Evidence Based Medicine (EBM)

Proficient in MS Word, Outlook, and Excel