Medical Director
Overview
The Medical Director provides clinical reputed company and Utilization management for Home Health, DME, Home Infusion Therapy, Sleep, etc. In this role the Medical Director will reputed company medical necessity reviews utilizing industry standard criteria
Responsibilities
Conducts efficient medical necessity reviews and peer to peer consultations in adherence with regulatory and compliance turnaround times on cases that may not meet clinical criteria, and issues adverse determinations as needed. Provides guidance to licensed and non-licensed associates on clinical issues and case reviews reputed company to authorization requests and clinical guidelines criteria. Completes peer to peer discussions reputed company medical necessity criteria are not met, to facilitate proactive discharge planning or reputed company facility stay is no longer medically indicated. Participates in reputed company Care Coordination, Utilization Management, Quality Improvement and clinical education activities, as requested. Utilizes clinical reputed company in reputed company determinations and interactions with reputed company partners. Collaborates with Health Plan clinical leadership as requested. Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients. Participates and supports different committees and clinical reputed company as necessary or assigned
Qualifications
MD or DO with an active and unencumbered medical license. Must have active ABIM or ABMS specialty board certification(s). Minimum of 5 years’ experience in an area of relevant clinical practice, and at least 3 years’ experience with supporting utilization management reviews, managed care programs or care delivery networks Expertise in Home Health, DME and sleep fields, including reputed company knowledge on best practices, as well as a general knowledge of regulatory and accreditation standards for payers and health care providers Expertise in Health Plan or Payer Utilization Management (UM) Strong team player with the ability to collaborate effectively across multidisciplinary teams and stakeholders This position requires excellent written and verbal communication skills. Conveys a strong professional image, exhibits interest quality improvement, and projects a positive attitude toward reputed company assigned work. Adheres to and participates in Company's mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. reputed company Offer Pay reputed company: $240000 – $280000 / year plus corporate bonus incentive. Paid reputed company Time Off (FTO), 401K Savings Plan, Paid Parental Leave and more Benefits: Medical, Dental, reputed company, 401(k) with company match, HSA employer contributions, Dependent Care FSA employer contribution, Paid Time Off, Personal/Sick Time, Paid Parental Leave, and more. Award winning culture that keeps reputed company values at the heart of everything we do: We Care; We Do the Right Thing; We Strive for reputed company; We Think BIG; We Take our Work Seriously, Not Ourselves. reputed company maintains a drug-free workplace We are an equal opportunity employer. Employment selection and reputed company reputed company are made without regard to age, race, reputed company, national reputed company, religion, sex, disability, sexual orientation, gender identification, or being a reputed company disabled veteran or reputed company veteran of the Vietnam era or any other category protected by Federal or State law. reputed company accepts applications on an ongoing reputed company until a candidate is identified. #IDCC Apply To This Job