Medical Director, Medical Management - Remote

Overview

The Medical Director, Medical Management, is responsible for ensuring utilization management responsibilities are performed according to clinical standards, reviewing escalated cases, and participating in multidisciplinary teams for case and disease management.

In Short

• Conduct electronic reviews of escalated cases.
• Determine medical necessity and appropriateness of requested services.
• Participate in multidisciplinary team discussions.
• Compose rationales for member and provider notifications.
• Ensure compliance with healthcare regulations.
• Manage special projects related to patient care.
• Advise on high-risk cases.
• Participate in protocol and guidelines development.
• Attend team huddles and grand rounds.
• Engage in continuous improvement initiatives.

Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required.
• 5 years of clinical experience required.
• 1 year of medical management experience preferred.
• Board certification in a recognized specialty required.
• Active medical state licensure required.
• Strong communication and collaboration skills.
• Critical thinking abilities.
• General computer skills necessary.
• Customer service orientation.
• Ability to travel occasionally.

Benefits

• Competitive salary range.
• Opportunity for professional development.
• Engagement in meaningful healthcare projects.
• Comprehensive benefits package.
• Supportive work environment.
• Collaboration with a multidisciplinary team.
• Flexibility in work arrangements.
• Access to resources for continuous learning.
• Participation in healthcare policy discussions.
• Contribution to improving patient care.