New York Licensed Medical Director

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

Key Responsibilities

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

Document clinical review findings in accordance with policies and regulatory requirements

Engage in peer-to-peer discussions with requesting providers and communicate benefit determinations

Required Qualifications

M.D. or D.O. degree

Active unrestricted license to practice medicine

Board certification approved by the American Board of Medical Specialties (ABMS)

5+ years of clinical practice experience after residency training

Sound understanding of Evidence Based Medicine (EBM)