Medical Director

Job Title: Medical Director
Location: 100% Remote (must reside in the US)
Duration: 06+ Months with the potential for hire

Schedule : Mon - Fri (General Shift Hours) EST - 40 hours with rotating weekend coverage; participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner

Job Summary:
Report To: Lead Medical Director

The Medical Director’s work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Client processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enProduct working in a team-based environment. Medical Directors support Client value throughout all activities.

Responsibilities:
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Client policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enProducts working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.

· Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services

· Maintain accountability for productivity, quality, and compliance metrics

· Communicate determinations clearly both verbally and in writing

· Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.

Required Qualifications:

· MD or DO degree

· 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or > 65 years of age).

· Current and ongoing Board Certification an approved ABMS Medical Specialty

· A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.

· No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

· Excellent verbal and written communication skills.

· Evidence of analytic and interpretation skills, with prior experience working in a team environment.