Inpatient Medicare Medical Director

This is a fully remote position, open to applicants in Arizona, +7 more states.

📋 Description

• Assist the Chief Medical Director in overseeing and coordinating medical management, quality improvement, and credentialing functions.

• Provide medical leadership for initiatives related to utilization management, cost containment, and enhancement of medical quality.

• Conduct utilization reviews, quality assurance, and medical evaluations of complex, controversial, or experimental services.

• Support performance improvement initiatives for capitated providers.

• Aid in the establishment of goals and policies aimed at enhancing the quality and cost-effectiveness of care.

• Offer medical expertise for programs focused on quality improvement and utilization management.

• Assist with the structure, processes, and membership of physician committees.

• Perform regular rounds for high-risk patients and facilitate care coordination with care management teams.

• Collaborate with clinical teams, network providers, appeals teams, and medical and pharmacy consultants on intricate cases and appeals.

• Engage in provider network development and expansion into new markets.

• Develop and implement educational initiatives for physicians on clinical issues and policies.

• Identify utilization review studies and assess adverse utilization trends, provider practice patterns, and benefit/payment adequacy.

• Identify clinical quality improvement studies to minimize unwarranted variation in clinical practice.

• Interact with physicians and providers to execute recommendations that enhance utilization and healthcare quality.

• Review complex, controversial, unusual, or new-service claims to assess medical necessity and appropriate payment.

• Foster provider-community alliances through medical management programs.

• Represent the business unit to local and national audiences as necessary.

• Represent the business unit on state and ad hoc committees.

⛳️ Requirements

• Medical Doctor (MD) or Doctor of Osteopathy (DO).

• Actively engaged in the practice of medicine.

• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services.

• Current state license as an MD or DO with no restrictions, limitations, or sanctions from government programs.

• Preferred experience in Utilization Management and understanding of quality accreditation standards.

• Board certification in Internal or Family Medicine is preferred.

• Coursework in Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.

• Experience in treating or managing care for a culturally diverse population is preferred.

• Availability to work weekends and holidays in support of business operations, as needed.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive opportunities may be included in total compensation.

• Equal opportunity employer dedicated to promoting diversity.