Medical Director – Medicaid

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Provide prompt and consistent replies to members and providers regarding precertification, concurrent review, and appeal requests.

• Primarily accountable for Utilization Management, which encompasses prior authorization, precertification, and concurrent review.

• Cases may involve inpatient or outpatient care, acute and post-acute services, as well as peer-to-peer discussions and initial level appeals.

• Engage in a rotating on-call schedule to ensure weekend and holiday support.

⛳️ Requirements

• A minimum of five years of experience in the Health Care Delivery System, such as Clinical Practice and the Health Care Industry.

• Possession of an active and current Louisiana state medical license without any restrictions, along with the capability to acquire licenses in Florida, Kentucky, and West Virginia.

• M.D. or D.O. degree with current and active Board Certification in an ABMS or AOA recognized specialty, including direct patient care experience post-graduation.

• Required specialization in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics.

• Experience in Utilization Management/Review within health plans or payors.

• Familiarity with electronic medical systems and records.

• Background in Managed Care.

• Experience with Medicaid.

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

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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