Medical Director - Utilization Management

A company is looking for a Medical Director Utilization Management - Clinical Advocacy and Support.

Key Responsibilities :

Conduct coverage reviews and render coverage determinations based on member plan benefits

Document clinical review findings and engage with providers in peer-to-peer discussions

Communicate and collaborate with network and non-network providers to ensure timely benefit determinations

Required Qualifications :

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

Board certification in an ABMS or AOA specialty

5+ years of clinical practice experience after completing residency training

Proven understanding of Evidence Based Medicine (EBM)

Ability to participate in rotational holiday and call coverage