You'll enjoy the flexibility of working remotely from anywhere within the U.S. while taking on challenging responsibilities. We are currently seeking Medical Directors available for daytime hours in the Pacific, Mountain, or Central Time Zones.
Primary Responsibilities
Provide daily oversight of utilization management and maintain external communication with network physicians and hospitals.
Conduct daily utilization management (UM) reviews, including authorizations and denial reviews.
Conduct peer-to-peer conversations for clinical case reviews as necessary.
Engage in telephonic reviews and discussions with providers, sharing tools, information, and guidelines related to cost-effective healthcare delivery and quality of care.
Effectively communicate with network and non-network providers to ensure successful administration of services.
Serve as a non-promotional medical contact point for healthcare providers' clinical inquiries.
Represent the organization at external levels, identifying, engaging, and maintaining relationships with thought leaders.
Collaborate with the Client Services Team to ensure coordinated delivery system approaches.
Contribute to the development of action plans and programs to implement strategic initiatives, monitoring progress towards goals.
Interact, communicate, and collaborate with network and community physicians, hospital leaders, and other vendors regarding enrollees' care and services.
Provide leadership and guidance to optimize cost management through close coordination with network and provider contracting.
Regularly participate in leadership meetings to review care coordination issues, develop collaborative intervention plans, and discuss network management matters.
Provide input to the Analytics Team and Client Services Team on local needs to enhance products and services.
Ensure timely management and resolution of local queries regarding patient case management.
Participate actively on the Medical Advisory Board.
Provide intermittent, scheduled weekend and evening coverage as needed.
Required Qualifications
Perform other duties and responsibilities as required or assigned.
Board certification as an MD, DO, MBBS with a current unrestricted license to practice and maintain necessary credentials.
Current, unrestricted medical license and ability to obtain licensure in multiple states.
Minimum of 3 years of post-residency patient care experience, preferably in an inpatient or post-acute setting.
Preferred Qualifications
Licensure in multiple states or willingness to obtain additional state licenses with support.
Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care.
Demonstrated ability to work within a team environment while managing multiple tasks.
Competence in using electronic health records and associated technology.
Excellent organizational, analytical, verbal, and written communication skills.
Strong interpersonal skills with the ability to build positive relationships across all levels.
High level of ethics, integrity, motivation, flexibility, and adaptability in a dynamic environment.
Compensation
Salary range varies based on experience and metrics achievement. In addition to competitive compensation, benefits include a comprehensive package, incentive programs, equity stock purchase, and 401k contributions (subject to eligibility).
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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