Utilization Review Medical Director (Remote)

MRIoA • Dallas, TX

1d • $240,000 • Remote

About The Position

We are currently seeking a full-time Medical Director (Physician Reviewer) to join our growing, fully remote team. In this role, you will apply your clinical expertise to evaluate requests for medical services, interpret benefit language and medical policies, and make sound coverage determinations. You may also engage in peer-to-peer discussions with treating providers. This position emphasizes independent clinical judgment, thorough

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.
• Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.
• Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree