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Medical Director
RxBenefits, Inc.Medical Director providing leadership and oversight for utilization management programs at RxBenefits. Collaborating with stakeholders and ensuring compliance with regulatory standards while conducting clinical reviews.
About the role
Key responsibilities & impact- Provides clinical leadership and oversight for RxBenefits' utilization management programs
- Conducts clinical medical necessity reviews of physician or member
- Serves as a peer-to-peer consulting physician as needed
- Coordinates with and audits third-party external review agencies
- Collaborates with Legal and Compliance teams for regulatory adherence
- Acts as the Medical Director of record for multiple states
- Participates in internal audits, compliance reviews, and quality improvement initiatives
Requirements
What you’ll need- Doctor of Medicine or Osteopathy from an accredited institution
- Active, unrestricted license to practice medicine
- Multiple State licenses preferred
- 5+ years of professional medical experience after completing residency training
- Demonstrated experience in utilization management and prior authorization required
- Pharmacy knowledge required; specialty drug utilization experience preferred
- Strong analytical skills and problem-solving skills
- Ability to translate clinical insights into business strategies and client solutions
- Exceptional collaborative partner with internal and external stakeholders
- Excellent written, verbal, and presentation skills
- Proficiency in Microsoft Office
- Occasional travel required
Benefits
Comp & perks- Website LinkedIn All Job Openings 1001 - 5000 employees Founded 1995 ⚕️ Healthcare Insurance 💳 Fintech 🤝 B2B 💰 Private Equity Round on 2020-12 Healthcare Insurance
- Fintech
- B2B RxBenefits, Inc. is a company that specializes in providing innovative pharmacy benefits solutions to employers and their employees. They focus on optimizing the management of prescription drug plans to reduce costs and improve health outcomes. Through advanced analytics and personalized member support, RxBenefits aims to transform the pharmacy benefits experience for their clients.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization managementmedical necessity reviewsprior authorizationpharmacy knowledgespecialty drug utilizationclinical insights translationquality improvement initiativesauditingclinical leadershipmedical director
Soft Skills
analytical skillsproblem-solving skillscollaborationcommunication skillspresentation skills
Certifications
Doctor of MedicineDoctor of Osteopathyactive medical license