Medical Director – Kentucky Medicaid

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

📋 Description

• Provide timely and consistent responses to members and providers regarding precertification, concurrent review, and appeal requests.

• Oversee Utilization Management, which includes prior authorization and precertification, as well as concurrent review.

• Concentrate on inpatient or outpatient care, acute and post-acute situations, along with peer-to-peer interactions and first-level appeals.

⛳️ Requirements

• At least five years of experience in the Health Care Delivery System, including Clinical Practice and the Health Care Industry.

• Possession of a valid and current Kentucky state medical license without any encumbrances, along with the ability to acquire licenses in Florida, Louisiana, and West Virginia.

• An M.D. or D.O. degree, along with current and active Board Certification in an ABMS or AOA recognized specialty, which includes post-graduate direct patient care experience.

• Preference for specialties in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.

• Prior experience in Utilization Management at a Health Plan or Insurer, or as a Physician Advisor, or with an Independent Review Organization is a plus.

• Experience in Health plan/payor Utilization Management and Review.

• Familiarity with electronic medical systems and records.

• Experience in Managed Care.

• Experience with Medicaid is advantageous.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• A comprehensive benefits package designed to support the physical, emotional, and financial well-being of employees and their families.