Medical Director – Clinical Ops Case Review

This is a fully remote position, open to applicants in Alabama, +17 more states.

📋 Description

• Provide support for care management, quality assurance, utilization management, credentialing, pharmacy services, implementation of health policies, technology assessment, and risk management activities.

• Conduct care management case reviews for cases that require medical necessity evaluation.

• Perform appeal case reviews for cases related to medical necessity assessment.

• Collaborate to establish priorities aimed at enhancing service delivery at the point of care.

• Execute quality of care complaint reviews for cases that involve clinical or service-related aspects.

• Engage in rotation for participation in relevant committees.

⛳️ Requirements

• Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO) is required.

• A minimum of 10 years of experience following the attainment of the degree.

• At least 5 years of experience in a leadership role.

• Must possess a valid medical license and hold current Board certification in an ABMS recognized specialty.

• The current medical license to practice must be free of any restrictions.

• Must be willing and capable of applying for medical licenses in other states as necessary.

🏝️ Benefits

• Competitive medical, dental, and vision plans, along with paid time off (PTO), holidays, paid volunteer time off, 401K contributions, caregiver services, and numerous other benefits to support our employees.