Medical Director - Vascular Surgery - Remote (West Coast)
About The Position
The Medical Director provides physician support to Enterprise Clinical Services, which conducts initial clinical reviews of service requests. The role collaborates with Enterprise Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage determinations, quality improvement, and cost-effective member services. Activities focus on applying clinical knowledge to utilization management, particularly pre-service benefit and coverage determinations and medical necessity reviews according to members’ benefit packages, as well as communicating with network and non-network physicians and other Enterprise Clinical Services teams. The Medical Director works with a multidisciplinary team and participates in managing medical benefits, often in collaboration with a member’s primary care provider or specialist. The role ensures members receive appropriate, cost-effective, quality medical care. This position is remote and may be performed from anywhere in the U.S. on the West Coast. The role includes participation in a call coverage rotation.
Requirements
- M.D. or D.O.
- Board certification in General Surgery through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA), with experience in Vascular Surgery.
- Active, unrestricted license to practice medicine.
- At least 5 years of clinical practice experience after completing residency training.
- Sound understanding of Evidence Based Medicine (EBM).
- Experience performing vascular surgeries and procedures.
- Solid PC skills, specifically using MS Word, Outlook, and Excel.
- Ability and willingness to participate in a call coverage rotation.
Nice To Haves
- Based on the West Coast (PST/MST).
- Experience in utilization and clinical coverage review.
- Excellent oral, written, and interpersonal communication skills and facilitation skills.
- Data analysis and interpretation aptitude.
- Innovative problem-solving skills.
- Excellent communication skills for both clinical and non-clinical audiences.
Responsibilities
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, and render coverage determinations.
- Document clinical review findings, actions, and outcomes in accordance with policies and regulatory and accreditation requirements.
- Engage with requesting providers in peer-to-peer discussions as needed.
- Interpret existing benefit language and policies when conducting clinical coverage reviews.
- Participate in daily clinical rounds as requested.
- Communicate and collaborate with network and non-network providers to support accurate and timely benefit determinations and educate providers on benefit plans and medical policy.
- Communicate and collaborate with internal partners.
- Participate in a call coverage rotation.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution, subject to eligibility requirements.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
