SVP Medical Director

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

📋 Description

• Evaluate medical reports that have been escalated due to insufficient information by utilizing evidence-based criteria;

• Provide leadership within a dedicated team comprising clinicians and claims professionals.

• Engage in client stewardship discussions, claim roundtables, and complex medical escalations.

• Stay updated on emerging medical trends, treatment standards, clinical literature, and evidence-based guidelines;

• Support issues related to workers’ compensation, disability, FMLA, fitness-for-duty, return-to-work, liability, and safety-sensitive workforces.

• Obtain and retain Medical Director licensure in select states as necessary.

• Apply relevant clinical guidelines and medical literature to back defensible recommendations, claim discussions, and treatment-plan clarifications.

• Engage with treating providers as necessary and assist with appeals, independent medical review considerations, peer review alignment, and clinical quality review.

• Document recommendations using templates in Juris and SharePoint, following the required format and referencing evidence-based criteria within the specified time frame.

• Develop and deliver training materials and presentations to address training needs.

• Interface and provide guidance and leadership to the Client dedicated leadership team as well as team leads.

⛳️ Requirements

• A Medical Doctor (M.D.) degree is mandatory.

• A minimum of ten (10) years of related experience is required, including one (1) to three (3) years in utilization review and three (3) years in clinical quality control.

• Familiarity with evidence-based guidelines.

• Knowledge of ADAA and FMLA.

• Understanding of utilization review procedures.

• Acquaintance with clinical quality systems and measurements.

• Knowledge of resources regarding regulations and parameters related to third-party reimbursement, benefit determinations, and payments.

• Awareness of statutory requirements in the state's jurisdiction and ERISA regulations.

• Understanding of general claim practices.

• Knowledge of pharmacy processes and pharmacy benefit management is a plus.

• Understanding of pain management is advantageous.

• Exceptional oral and written communication skills, including presentation abilities.

• Proficient in PC usage, including Microsoft Office products.

• Strong analytical and interpretive skills.

• Excellent organizational capabilities.

• Outstanding interpersonal skills.

• Proven management and leadership abilities.

• Capacity to create and produce comprehensive, accurate, and constructive written reports.

• Ability to work effectively in a team environment.

🏝️ Benefits

• A selection of three medical plans, along with two dental and vision plans.

• Tuition reimbursement options.

• A 401K plan that matches 50% of every dollar contributed, up to the first 6% saved.

• Four weeks of PTO during your first full year.

• Reasonable accommodations provided when applicable and appropriate.