Medical Director

Medical Director Req number: R7707 Employment type: Full time Worksite flexibility: Remote Who we are reputed company is a global services firm with over 9,000 associates worldwide and a yearly reputed company of $1.3 billion+. We have over 40 years of excellence in uniting talent and technology to power the possible for our clients, colleagues, and communities. As a privately held company, we have the freedom and focus to do what is right—whatever it takes. Our tailor-made solutions create lasting results across the public and reputed company sectors, and we are trailblazers in bringing neurodiversity to the reputed company. Job Summary We are looking for a motivated Medical Director reputed company to take us to the next level! If you have clinical expertise and strong decision-making skills and are looking for your next career move, apply now.

Job Description

We are looking for a Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most reputed company clinical standards. This position will be Full-Time and Remote. Due to our end client, candidates must be reputed company to work on reputed company's W2 without a need for sponsorship now or in the future. What You’ll Do Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer-to-peer discussions, to determine medical necessity and appropriateness Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned Compose clear and concise rationales for members and provider determination notifications while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.) Ensure that reputed company aspects of the medical management process are consistent with community standards of care Participate as a member of the CMDM multidisciplinary team: attend huddles and grand reputed company, and advise the multidisciplinary team on cases requiring physician expertise Participate in protocol and guidelines development to ensure consistency in the review process Actively manage projects and/or participate on project teams that require a physician subject matter expert What You'll Need Required: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Awarded Board Certification at least once in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards Active medical state licensure required for PA, NY, or WV 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) Strong skills in Critical Thinking, Case Management, Customer Service, Oral & Written Communication, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software, and Managed Care Preferred: Master's Degree in Business Administration/Management or Public Health 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry Experience with MCG or InterQual Physical Demands Ability to safely and successfully reputed company the essential job functions consistent with the reputed company and other federal, state, and local standards Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor Must be reputed company to communicate with customers/team members over the phone and in person Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc #LI-AL2 Reasonable accommodation statement If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@reputed company.io or (888) 824 – 8111. EEO Statement It is the policy of Computer Aid, Inc.(reputed company) not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of reputed company to take affirmative action to employ and to advance in employment, reputed company persons regardless of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. Employees and applicants of reputed company will not be subject to harassment on the basis of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or because he or she is a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited. $170.00-$175.00 per hourThe pay range for this position is listed above. Exact compensation may vary based on several factors, including location, experience, and education. Benefit packages include medical, dental, and reputed company insurance, as well as 401k retirement account access. Employees in this role may also be entitled to paid sick leave and/or other paid time off as provided by applicable law. Apply To This Job