Medical Director - Utilization Management (Remote)

MRIoA•Salt Lake City, UT

4d•Remote

About The Position

Our Medical Director, also known as a Physician Advisor, is responsible for performing clinical utilization management, peer review activities, and clinical quality management activities. This role is designed to be a remote position (work-from-home).

Requirements

Minimum of five years’ full-time equivalent experience providing direct clinical care to patients.
MD/DO degree.
Current, unrestricted medical license as required for clinical practice in a state of the United States.
Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
All candidates are required to pass a Background Screen before beginning employment.
All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.
Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

Nice To Haves

Minimum of five years’ experience administering utilization management and peer review programs preferred.
Credentialed and privileged by the Company's Credentialing Committee.
Obtain additional state licensure as required for the position.
Board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) or other board recognized by URAC preferred.

Responsibilities

Perform utilization management case reviews.
Maintain productivity score per company standard.
Maintain annual quality score per company standard.
Complete annual inter-rater reliability testing.
Train across all queues as requested by MRIoA leadership.
Complete all client specific training as requested by MRIoA leadership.
Maintain up-to-date records of case completion if required.
Consistently show willingness to take cases as requested.
Demonstrate respect in interactions across the company.
Consistently submit scheduling requests at least three months in advance.
Consistently work scheduled hours.
Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team.
Actively participate in the MRIoA evaluation process (both company and individual).
Participate in all company meetings and committees as requested.
Complete other duties as requested or approved by the CEO and/or chief medical officer.
Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards.