Weekend Associate Medical Director – 0.3 FTE

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

📋 Description

• Support the CMO in assessing the availability, suitability, and necessity of care provided by both participating and out-of-plan providers.

• Engage in the oversight and clinical decision-making processes of the Utilization Management (UM) program.

• Aid in the creation of quality care guidelines, internal peer review protocols, and the assessment of medical care evaluation studies.

• Offer medical consultation regarding medical/legal matters, member grievance processes, and the design of new benefit packages.

• Foster a positive relationship between NHP and the medical community.

• Act as a representative for NHP within the medical community while maintaining appropriate connections with professional healthcare organizations.

• Take part in the continuous recruitment of plan physicians.

• Assist in formulating suitable medical guidelines and parameters for claims assessment.

⛳️ Requirements

• Doctor of Medicine (MD or DO) licensed in Wisconsin with no restrictions.

• Member in good standing within the local medical community.

• Actively practicing medicine in the NHP service areas.

• Comprehensive understanding of health professionals, facilities, and standards of medical practice within NHP’s service area.

• Adequate medical experience and familiarity with the Medicare program to evaluate organizational determinations regarding medical necessity.

• Board-certified in an ABMS medical specialty.

🏝️ Benefits

• Opportunity to work diligently and enjoy yourself while being compensated for volunteering in your local community.

• Reliable internet connection is necessary for remote work.

• Some travel may be required.