Medical Director - Utilization Management (Remote)

MRIoA•Mountain View, CA

5d•Remote

About The Position

Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations. Excellence starts with our people. Our Medical Director, also known as a Physician Advisor, is responsible for performing clinical utilization management, peer review activities, and clinical quality management activities.

Requirements

Minimum of five years’ full-time equivalent experience providing direct clinical care to patients
Credentialed and privileged by the Company's Credentialing Committee
Obtain additional state licensure as required for the position
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.

Nice To Haves

Minimum of five years’ experience administering utilization management and peer review programs preferred
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