DC and MD Licensed Medical Director

A company is looking for a Lead Medical Director for Utilization Management.

Key Responsibilities

Oversee the execution of case management, disease management, and utilization review operations

Conduct daily reviews of inpatient cases, precertification requests, and pharmacy requests

Make utilization review decisions based on medical necessity and coverage criteria

Required Qualifications and Education

5 years of clinical experience with leadership responsibilities

Health plan experience preferred

Medical licensing in DC and Maryland is required

Residency in the DC / Maryland area is necessary

Experience in primary care and health plan operations