Growth Opportunity - Medical Director (Utilization Review)

MRIoA•Mountain View, CA

37d•Remote

About The Position

As a Medical Director, you will use your clinical expertise to evaluate clinical service requests, interpret benefit language and medical policies, and render coverage determinations. You may also participate in peer-to-peer conversations with treating providers. This is a fully remote, salaried position with a strong emphasis on clinical judgment, documentation accuracy, and collaboration with fellow Medical Directors.

Requirements

MD or DO degree, with current board certification in Family Medicine or Internal Medicine.
5 years of recent direct patient care experience, with 3 full years of in-patient hospital experience in an acute care setting - strongly preferred.
Be highly adept with computers, with strong computer literacy.
Be willing to obtain up to 20 additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them).
Clean background, without any prior licensure issues or pending/prior malpractice (background or malpractice issues can delay the process of obtaining additional licenses).
Must have passed each component of the USMLE, COMLEX-USA, or equivalent predecessor exam accepted by the state medical board (such as the FLEX or NBME) in no more than three attempts for each component.
You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours.
You must reside and work within the United States.

Responsibilities

Conduct clinical coverage reviews using member benefits and established clinical guidelines.
Interpret benefit language and policies to support review determinations.
Document review findings in accordance with regulatory, accreditation, and internal standards.
Engage in peer-to-peer discussions with treating providers when needed.
Collaborate with a nationwide team of Medical Directors.