Job Details:Responsibilities:- The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Facilities policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
- Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
- Maintain accountability for productivity, quality, and compliance metrics
- Communicate determinations clearly both verbally and in writing
- Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices
Preferred Qualifications- Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
- Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
- Experience with national guidelines such as MCG or InterQual
- Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists
- The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
- Ability to thrive in a dynamic, fast-paced, team-oriented environment.
- Commitment to a culture of innovation, including being facile with using technology to improve workflows
- Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
- Passionate about contributing to an organization s focus on consistency in outcomes, consumer experiences and a highly engaged team culture
Schedule: 40 hours with rotating weekend coverage; participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner
Requirements- MD or DO degree
- 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
- Current and ongoing Board Certification an approved ABMS Medical Specialty
- A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
- Excellent verbal and written communication skills.
- Evidence of analytic and interpretation skills, with prior experience working in a team environment
