Medical Director

This is a fully remote position, open to applicants in Louisiana, +4 more states.

📋 Description

• Perform electronic evaluations of escalated cases in accordance with medical policy guidelines.

• Execute initial case determinations, review appeals and grievances, along with other assigned evaluations.

• Draft clear and concise rationales for notifications regarding member and provider determinations.

• Collaborate as a member of the CMDM multidisciplinary team.

• Provide guidance to the multidisciplinary team on cases that necessitate physician expertise.

• Actively oversee projects and/or engage in project teams that require a physician subject matter expert.

⛳️ Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.

• Minimum of 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice).

• At least 1 year of experience in Medical Management within a Health Insurance Plan is preferred.

• Board Certification in at least one specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards.

• Active medical state licensure is mandatory.

• Strong understanding of the managed care industry is preferred.

🏝️ Benefits

• Comprehensive health insurance package.

• Competitive salary and performance-based bonuses.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork.