Medical Director – Cardiovascular Medicine

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

📋 Description

• Evaluate the medical appropriateness of services by analyzing clinical information and implementing evidence-based guidelines.

• Assist the clinical development team in assessing clinical decision guidelines and reviewing evidence-based literature.

• Offer expert insights on content and programs that influence cardiovascular care for physicians to enhance patient outcomes.

• Deliver prompt medical reviews that meet established quality and timeliness standards.

• Make clinical assessments utilizing evidence-based criteria and professional judgment.

• Precisely document communications and decision-making processes within Cohere workflow tools.

• Utilize appropriate templates for recording case-review decisions.

• Engage in peer-to-peer discussions with treating providers to clarify clinical information and articulate review results.

• Provide constructive feedback on alternative treatments based on medical necessity criteria and evidence-based research.

• Exhibit professionalism, accountability, and service in interactions with colleagues and providers.

• Participate in projects aimed at enhancing the team's clinical expertise and efficiency.

• Contribute to operational improvements and the member/provider experience related to clinical review tasks.

⛳️ Requirements

• Completion of a U.S.-based residency in Internal Medicine and a fellowship in Cardiology.

• Board certification (MD or DO) with an active, unrestricted state medical license; must uphold all required credentials.

• Over 5 years of clinical experience beyond residency/fellowship in Internal Medicine or Cardiology.

• Membership in national and/or regional specialty societies.

• Willingness to acquire additional state licenses with Cohere's assistance.

• Capability to multitask and manage assignments to completion in a timely and organized manner.

• Ability to thrive in a matrix organization.

• Exceptional written and verbal communication skills.

• Familiarity with technology and eagerness to learn new software tools.

• Comprehension of the managed care regulatory framework and processes.

• Detail-oriented, adaptable, and capable of working independently with minimal supervision.

• Agreement to fully cooperate with Cohere by obtaining state licenses or registrations as required.

• A minimum of 1 year of experience in managed care utilization review is preferred.

• Licensure in FL, MN, ND, or TX is highly desirable.

🏝️ Benefits

• Fully remote position with approximately 5% travel required.

• Comprehensive benefits package including medical, dental, vision, life, disability insurance, and Employee Assistance Program.

• 401K retirement plan with company matching contributions.

• Flexible spending account and health savings account options.

• Flex Time Off and company-recognized holidays.

• Up to 14 weeks of paid parental leave.

• Pet insurance available.

• Bonus included within the total benefits package.