Medical Director
CAI•,
•Remote
About The Position
We are looking for a motivated Medical Director ready to take us to the next level! If you have clinical expertise and strong decision-making skills and are looking for your next career move, apply now. We are looking for a Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most current clinical standards. This position will be Full-Time and Remote. Due to our end client, candidates must be able to work on CAI's W2 without a need for sponsorship now or in the future.
Requirements
- Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
- Awarded Board Certification at least once in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
- Active medical state licensure required for PA, NY, or WV
- 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
- Strong skills in Critical Thinking, Case Management, Customer Service, Oral & Written Communication, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software, and Managed Care
Nice To Haves
- Master's Degree in Business Administration/Management or Public Health
- 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
- Experience with MCG or InterQual
Responsibilities
- Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer-to-peer discussions, to determine medical necessity and appropriateness
- Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned
- Compose clear and concise rationales for members and provider determination notifications while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.)
- Ensure that all aspects of the medical management process are consistent with community standards of care
- Participate as a member of the CMDM multidisciplinary team: attend huddles and grand rounds, and advise the multidisciplinary team on cases requiring physician expertise
- Participate in protocol and guidelines development to ensure consistency in the review process
- Actively manage projects and/or participate on project teams that require a physician subject matter expert
Benefits
- medical, dental, and vision insurance
- 401k retirement account access
- paid sick leave
- other paid time off as provided by applicable law
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
