Medical Director

About This Role

Serve as a Medical Director responsible for reviewing medical records, synthesizing complex clinical scenarios, and providing expert determinations on requested services. Engage with external providers to gather information and ensure compliance with medical policies and guidelines.

Responsibilities

• Provide medical interpretation and determinations on services provided by healthcare professionals, ensuring concordance with national guidelines, CMS requirements, Client policies, and clinical standards.
• 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.

Requirements

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship
• Current and ongoing Board Certification in an approved ABMS Medical Specialty
• A current and unrestricted medical license in at least one jurisdiction and willingness to obtain additional licenses
• 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

Qualifications

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship, preferably including inpatient or Medicare-type population care.

Nice to Have

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products
• Utilization management experience in a medical management review organization
• Experience with national guidelines such as MCG® or InterQual
• Experience in hospital-based clinical practice, including Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists
• Curiosity to learn and flexibility to adapt to changes
• Ability to thrive in a dynamic fast-paced, team-oriented environment
• Commitment to a culture of innovation, including being facile with using technology

Certifications