Medical Director - Texas Licensed (5pm-9pm CT)

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.

Position Summary

The Clinical Enterprise department provides clinical business support to the entire company and provides clinical support for Capital Rx’s clinical utilization management (UM) programs, consultative support to the Pharmacy and Therapeutics (P&T) process, formulary development, drug information services and client activities as assigned. This position will report to the Lead Medical Director. This position transacts UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to Capital Rx’s coverage policies. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a stakeholder across the enterprise.

Position Responsibilities

• Medical Director will complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients; governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate
• Makes clinical determinations in accordance with medical necessity and criteria
• Performs scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribers
• Follow all internal procedures, job aids, and HIPPA guidelines to protect patient privacy and data security
• Support the Department’s responsibilities to provide peer-to-peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisions
• Communicates effectively and confidently with members to promote positive health outcomes
• Actively participates in the development of utilization management (PA) criteria and clinical policy revisions/reviews
• Ability to work in a fast-paced environment with shifting priorities
• Weekend on-call responsibilities (shared rotating call)
• Attention to detail and commitment to delivering high-quality work

Minimum Qualifications

• Must be a graduate of an accredited Medical School and Residency Program
• Active Texas medical license, required
• No history of disciplinary actions on Medical License
• Minimum 5 years history of clinical practice with direct patient care
• Specialty-Internal Medicine
• Board certified by appropriate Medical Board (DO, MD)
• Be able to satisfy rotating weekend call schedule with another Medical Director
• Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia
• Required annual Continuing Medical Education (CME) up to date