Medical Director
Medical Director
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
Remain current and proficient in CMS criteria hierarchy and organizational determination processes
Participates in case review and medical necessity determination
Maintain proficiency in compliance regulations for both CMS and delegated health plans
Conducts post service reviews issued for medical necessity and benefits determination coding
Assists in development of medical management care management and utilization management protocols
Performs all other related duties as assigned.
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Doctor of Medicine (M.D.) Doctor of Osteopathy (D.O.) or M.B.B.S.
Board certification in Family Medicine or Internal Medicine
An active unrestricted medical license (any state)
5 years of post-residency clinic practice experience
Proficiency with Microsoft Office applications
Preferred Qualifications:
2 years of experience in utilization management activities
2 years of experience with acute admissions
2 years of experience working in a managed care health plan environment
Bilingual (English/Spanish) fluency
Required Experience:
Director
Employment Type
Full-Time
