State Licensed Medical Director 3072740 I.Html
Job Description
To support healthcare facilities, the full-time State Licensed Medical Director will serve as a clinical resource, managing peer-to-peer consultations, educating physicians on documentation practices, and facilitating payer approvals while working remotely.
##### Key responsibilities
Conduct peer-to-peer reviews with health plan counterparts for denied inpatient cases
Educate physicians on ICD coding guidelines and clinical terminology to improve documentation accuracy
Analyze utilization review metrics and collaborate with hospital committees to develop denial reduction strategies
##### Required qualifications
Licensed (or eligible for licensure) Physician (MD/DO) in a U.S. state
Board Certification required, preferably in Internal Medicine or Family Medicine
Minimum of 5 years of clinical practice experience
Knowledge of InterQual, Milliman, or similar evidence-based criteria sets
Familiarity with Joint Commission, State and Federal standards, and reimbursement models
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