Medical Director - MN Licensed - job 1 of 2

Job Summary

A company is looking for a Medical Director - Medical Claims Review - Remote.

Key Responsibilities:

• Conduct coverage reviews based on individual member plan benefits and render 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 network and non-network providers

Required Qualifications:

• M.D. or D.O. degree
• Active unrestricted license to practice medicine
• Board certification approved by the AMBS or AOBMS specialty
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)