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

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health .

Position Summary:

The Clinical Enterprise department provides clinical business support to the entire company and provides clinical support for Judi Health'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 Judi Health'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 and must remain current in medical and management areas during employment

Demonstrated experience in clinical outcomes, working knowledge of medical statistics, regulatory agencies, and analytic programs

Ability to work with virtual teams of pharmacists

Time management skills to meet organizational goals

Knowledge of PBM environment, quality improvement and UM practices in a managed care environment

Knowledge of and appreciation for requirements of regulatory and accreditation agencies

Able to manage multiple priorities and deadlines

Excellent verbal, written, interpersonal and presentation skills

Strong knowledge of clinical medicine, health care delivery and the ability to acquire new scientific and medical knowledge

Proficiency with Microsoft Office applications. (e.g., MS Word, Excel, and PowerPoint minimum)

Preferred Qualifications:

Subspecialty board certification in addition to internal medicine (i.e. Rheumatology, Gastroenterology)

Willing to obtain additional medical license

Licensed in multiple states. Unrestricted without disciplinary actions (AZ, NC, MN, MI, TN or others)

This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary Range

$79,800 — $126,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy .