Perform clinical coverage reviews using member benefits, medical policies, and established clinical guidelines
Interpret benefit language to support accurate and compliant determinations
Document review outcomes in alignment with regulatory, accreditation, and internal standards
Participate in peer-to-peer discussions with treating providers as needed
Collaboration with Medical Directors across multiple specialties and regions

Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state.
Hold current board certification in either Family Medicine or Internal Medicine.
Possess a minimum of 5 years of direct patient care experience, most recent experience no less than 6 months ago.
High level of computer proficiency and comfort with multiple software programs.
Ability to be fully dedicated during scheduled work hours is required, productivity standards requirements must be met.
Must reside and work within the United States.

All necessary computer equipment is provided
Malpractice insurance is not required, as physicians do not provide direct patient care.
Reviewers are covered under MRIoA's Errors and Omissions policy.

Part-Time Associate Medical Director

Key skills