Medical Director – Post Acute Care

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

📋 Description

• Conduct timely expert medical evaluations of medical necessity requests for clinical services associated with post-acute care, providing clinical opinions on the services under review, including post-decision assessments.

• Engage in prompt and collegial discussions with treating physicians to clarify clinical details and convey the outcomes of reviews.

• Participate in proactive peer-to-peer consultations to facilitate appropriate and timely discharge planning.

• Document all activities related to clinical review sessions and certify review qualifications as necessary.

• Hold weekly Case Conferences with nursing and social worker teams, discussing each member receiving care in a post-acute facility, focusing on discharge planning, complex medical care management, quality of care, suitable levels of care, and optimal lengths of stay.

• Maintain required credentials and promptly notify eviCore of any adverse actions concerning medical licenses and/or board certifications.

• Assist in reviewing eviCore clinical guidelines.

• Communicate eviCore policies and procedures to the provider community.

• Provide testimony at ALJ Hearings when cases are under appeal.

• Support staff educational training and in-service programs, serving as a clinical resource for eviCore personnel.

• Act as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable.

• Be available for scheduled weekend calls from home based on business needs.

• Participate in Joint Operating Committee (JOC) meetings, including data collection and review relevant to the client, as well as other virtual events with the provider engagement team in your designated territory.

• Engage in all required educational and quality improvement initiatives, maintaining satisfactory scores in all assessments.

• Assist in reviewing case determinations from clients in response to provider or member complaints.

• Maintain necessary credentials and immediately report any adverse actions regarding medical licenses and/or board certifications to eviCore.

• Perform other assigned duties.

⛳️ Requirements

• M.D. or D.O. degree from an accredited institution.

• A minimum of five (5) years of clinical practice experience following the completion of all graduate medical education training, including residency and fellowship (if applicable).

• Active board certification in Physical Medicine and Rehabilitation.

• An active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine.

• Knowledge of relevant state and federal laws, URAC and NCQA standards, as well as utilization management.

• Ability to type at least 30 WPM, possess proficient computer skills, and have knowledge of Microsoft Office applications.

• Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10 Mbps download and 5 Mbps upload.

🏝️ Benefits

• Medical, vision, dental, and well-being and behavioral health programs.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement.

• A minimum of 18 days of paid time off per year.

• Paid holidays.