Medical Director (Remote)

MRIoA • Mountain View, CA

4h • $240,000 • Remote

About The Position

Our Medical Director, also know as Physician Advisor, leverages their medical experience and judgment to determine whether requested services, levels of care, and/or sites of service should be authorized. This role operates within a framework of criteria from the patient’s healthcare plan, regulatory compliance, and utilizing diverse resources such as national clinical guidelines, CMS policies, clinical reference materials, internal teaching conferences, and other references.

Requirements

• Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state.
• Hold current board certification in either Family Medicine or Internal Medicine (no other board-certified specialty is currently needed).
• Possess a minimum of 5 years of direct patient care experience, with the most recent experience no less than 6 months ago (recent clinical care is essential).
• Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
• Have a clean background, without prior licensure issues, pending malpractice cases, or legal issues.
• Possess excellent verbal and written communication skills.
• Excellent interpretation skills, divergent/creative thinking skills.
• Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.

Responsibilities

• Medical Decision Making: Leverage in-depth inpatient clinical expertise, including familiarity with MCG/InterQual guidelines and health plan policies, along with acute care, co-morbidities, and disease management experience, to review medical records and deliver evidence-based determinations on service requests.
• Communication: Conduct peer-to-peer phone calls with external providers to obtain additional clinical information and discuss case determinations.
• Collaboration: Follow established procedures to support internal workflows and foster effective working relationships across teams and stakeholders.
• Compliance and Support: Ensure all decisions and processes adhere to national guidelines, CMS regulations, URAC standards, clinical best practices, and contractual requirements.

Benefits

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed
• Number of Employees: 101-250 employees