Associate Medical Director - Utilization Management - Remote

Overview

The Associate Medical Director is responsible for clinical oversight of the utilization management program, including training and quality management, while providing governance to physician reviewers.

In Short

• Perform quality assurance training and audits on physician reviewers.
• Serve as the clinical lead for the Group Health Department.
• Assist with quality assurance of reports prior to submission to clients.
• Conduct random case audits in accordance with company policy.
• Lead URAC accreditations and facilitate Quality Management Committee meetings.
• Respond to Credentialing Committee requests and be familiar with clinical guidelines.
• Oversee the credentialing of physician advisors.
• Must be accessible to clinical and non-clinical staff for at least 20 hours per week.

Requirements

• Board Certified M.D. or D.O. with an unrestricted clinical license in the U.S.
• Minimum five years postgraduate experience in a clinical setting.
• Experience in Utilization Management with criteria review.
• Working knowledge of URAC and compliance guidelines.
• Excellent communication and critical thinking skills.
• Computer literacy and typing skills required.

Benefits

• Opportunity for leadership in a clinical setting.
• Flexible work from home arrangement.
• Engagement in quality management and improvement initiatives.