Wisconsin Licensed Associate Medical Director

Job Summary

A company is looking for an Associate Medical Director.

Key Responsibilities

• Conduct medical necessity reviews and determinations for prior authorizations and referrals
• Provide medical expertise for utilization management decisions and quality improvement activities
• Offer clinical strategy and physician input to health plan subcommittees as assigned

Required Qualifications

• MD or DO with current Board Certification in an ABMS Medical Specialty
• Unrestricted medical license in Wisconsin and other states as needed
• 5+ years of medical practice experience post residency or fellowship, preferably in managed care
• Knowledge of medical management principles and experience with national guidelines
• Familiarity with NCQA HEDIS principles and CMS Star ratings for Medicare lines of business