Utilization Review Medical Director - Remote

MRIoA • Pacifica, CA

94d

About The Position

Medical Review Institute of America (MRIoA) is experiencing continued growth and is seeking a full-time, remote Medical Director (Physician Reviewer) to join our team. For over 40 years, MRIoA has been a market leader in utilization management and clinical review solutions. Our Medical Directors play a critical role by applying their medical expertise to evaluate clinical service requests. Using professional judgment, Medical Directors determine whether requested services meet patient healthcare plan criteria and, in some cases, nationally accepted clinical guidelines. Reviews may involve peer-to-peer discussions with treating providers as needed.

Requirements

• Hold active state licensure as a Medical Doctor (MD/DO), any state.
• Hold current board certification in either Family Medicine or Internal Medicine.
• Possess a minimum of 5 years of direct patient care experience post training, with the most recent experience no less than 6 months ago.
• Have recently (within the past 2 years) worked in an inpatient/hospital setting.
• Be willing to obtain up to 20 additional state licenses.
• Have a clean background, without prior licensure issues, pending/prior malpractice cases or legal issues.
• Possess excellent verbal and written communication skills.
• Excellent interpretation skills, divergent/creative thinking skills.

Nice To Haves

• Must be fully dedicated to the job during your scheduled hours.
• Malpractice insurance is not required, as physicians do not provide direct patient care.

Responsibilities

• Conduct coverage reviews using critical thinking and clinical expertise, based on individual patient/member benefits and national or proprietary coverage review policies.
• Interpret benefit language and policies to guide clinical coverage determinations.
• Document clinical review findings and outcomes in compliance with organizational, regulatory, and accreditation standards.
• Engage in peer-to-peer consultations with prescribing providers when appropriate.
• Collaborate and communicate effectively with fellow Medical Directors.

Benefits

• Healthcare, vision, and dental insurance
• 401(k) retirement plan with generous company match
• 33 days of paid time off per year
• Additional employee benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed
• Number of Employees: 251-500 employees