Supervisory Medical Director – National Physical Health Appeals, Outpatient UM

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

📋 Description

• Delivers medical and leadership expertise to guarantee high-quality, cost-effective care for our members.

• Aids the Senior Medical Director and Chief Medical Officer in the implementation of operational and strategic clinical initiatives.

• Offers operational leadership, coaching, and mentorship to a team of front-line medical directors.

• Engages in the development and updates of training for both new hires and current medical directors.

• Assists the Chief Medical Officer and Senior Medical Director in executing strategic clinical initiatives.

• Participates in utilization review studies, performance management, and trend analysis activities.

• Manages complex and high-profile utilization management cases, ensuring timely and appropriate decision-making.

• Conducts and takes part in case escalation reviews, working collaboratively with healthcare providers and market leadership to resolve disputes or complaints.

• Oversees and actively engages in the appeals process, ensuring that appeals are managed efficiently, thoroughly, and in line with regulatory requirements.

• Provides clinical guidance and training to the appeals medical director team regarding regulatory updates.

• Collaborates closely with clinical teams, UM teams, and network providers to ensure comprehension and adherence to utilization management clinical coverage criteria.

⛳️ Requirements

• Medical Doctor (MD) degree from an accredited medical school is required.

• A Master's Degree in MBA, MPH, or an epidemiologist degree is preferred.

• Over 5 years of managed care/clinical experience; familiar with commercial, Medicare, and Medicaid lines of business is required.

• At least 1 year of supervisory/management experience is preferred.

• Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services is required.

• American Board Certification in Internal or Family Medicine is preferred.

• MD - Physician - State Licensure: Current state license as an MD or DO without restrictions, limitations, or sanctions from government programs is required.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K and stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements with remote, hybrid, field, or office work schedules