Medical Director, Physician Reviewer
Posted 43ds ago
Employment Information
Job Description
Medical Director performing clinical coverage determinations and peer-to-peer reviews for MRIoA, a utilization management and clinical review company.
Responsibilities:
- Conduct coverage reviews based on individual patient/member plan benefits, and/or national and proprietary coverage review policies, then render coverage determinations.
- Interpret existing benefit language and policies in the process of clinical coverage reviews.
- Document clinical review findings and outcomes in accordance with policies and regulatory and accreditation requirements.
- Take part in peer-to-peer discussions with prescribing providers, as needed.
- Communicate and collaborate with other Medical Director colleagues.
- Work scheduled 40 hours per week, 5 8-hour shifts, or 4 10-hour shifts (after training), scheduled between 6am to 7pm MST (8am – 9pm EST) including weekend rotation 2-3 days per month.
- Use provided company computer equipment hard-wired via Ethernet (Wi-Fi not permitted).
Requirements:
- Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state.
- Hold current board certification in either Family Medicine or Internal Medicine (no other specialty board certification is currently needed).
- Possess a minimum of 5 years of direct patient care experience post training, with the most recent experience no less than 6 months ago (recent clinical care is essential).
- Have recently (within the past 2 years) work in an inpatient/hospital setting.
- Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
- Have a clean background, without prior licensure issues, pending malpractice cases or legal issues.
- Possess excellent verbal and written communication skills.
- Excellent interpretation skills, divergent/creative thinking skills.
- Must be fully dedicated to the job during your scheduled hours.
- All candidates are required to pass a Background Screen before beginning employment.
- All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.
Benefits:
- healthcare insurance
- vision and dental insurance
- a 401(k)-retirement plan with a generous company match
- 33 days of paid time off per year
- All computer equipment necessary for the position is provided
