Medical Director

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct reviews of appeals based on medical necessity

• Oversee the decision-making procedures related to appeals

• Assist clinical operations and enhance communication among stakeholders

• Evaluate and provide determinations on complex clinical appeals

• Offer clinical expertise and guidance in the assessment of appeals

• Collaborate with cross-functional teams

• Aid in the creation and execution of clinical guidelines and protocols

• Act as a liaison between the organization and its stakeholders

• Engage in quality assurance initiatives

• Remain updated on industry trends, regulations, and best practices

⛳️ Requirements

• Doctoral degree in Medicine (MD or DO) from an accredited institution is required

• A Bachelor's or Master's degree in Business Administration, Healthcare Administration, or Medical Management is preferred

• Completion of a residency training program is mandatory

• A minimum of five (5) years of clinical practice experience is required

• Five (5) years of experience in managed care medical review or as a medical director is preferred

• Exceptional verbal and written communication skills

• Proficiency in clinical decision-making

• Knowledge of healthcare policies

• Experience in appeals processing

• Ability to communicate effectively with stakeholders

• Strong medical expertise

• Focus on outcomes improvement

• Commitment to policy adherence

• Familiarity with medical necessity criteria and clinical guidelines

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Opportunities for professional development

• Performance-based bonuses