Massachusetts Licensed Medical Director

A company is looking for a Medical Director, Clinical Reviews.

Key Responsibilities

Perform clinical reviews for utilization management, including prospective, concurrent, and retrospective coverage requests

Communicate with providers and facilities to resolve clinical issues and support the provider inquiry process

Conduct quality of care reviews and assist with credentialing reviews for providers and facilities

Required Qualifications

Current unrestricted license as a medical or osteopathic doctor

Board-Certified MD or DO in a specialty recognized by the American Board of Medical Specialties

Minimum of five years of clinical experience

Experience in utilization management or quality management preferred

Ability to perform utilization management activities in accordance with accreditation standards