Medical Director with State License

To ensure the highest clinical standards in utilization management, the full-time remote Medical Director with State License will conduct electronic reviews of cases, manage medical necessity determinations, and participate in multidisciplinary team discussions. Key responsibilities Conduct electronic reviews of escalated cases to determine medical necessity and appropriateness Complete initial determinations, reviews of appeals, and compose rationales for member notifications Participate in protocol development and manage projects requiring physician expertise Required qualifications Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Board Certification in a recognized specialty Active medical state licensure in PA, NY, or WV 5 years of clinical direct patient care experience Strong background in medical management and familiarity with compliance standards