Associate Medical Director
Job Summary
This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. The Associate Medical Director influences departmental strategy, leading and overseeing a team of physicians to ensure efficient management and quality standards. You will report directly to the Senior Medical Director while operating in a remote capacity.
Responsibilities
- Perform medical reviews and clinical determinations
- Lead and manage a team of physicians
- Conduct peer-to-peer discussions with providers
- Ensure compliance and quality standards for clinical reviews
Required Skills
- MD or DO board certification
- Unrestricted medical license
- Utilization review experience
- Managed care industry knowledge
Job Details
Responsibilities:
- Provide timely medical reviews that meet stringent quality parameters.
- Provide clinical determinations based on evidence-based criteria and internal guidelines and policies, while utilizing clinical acumen.
- Clearly and accurately document all communication and decision-making in workflow tools, ensuring a member could easily reference and understand the decision.
- Use correct templates for documenting decisions during case review.
- Receive and review escalated reviews.
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions.
- Manage direct reports and oversee their performance.
- Provide oversight to ensure the team meets turn-around times for clinical reviews.
- Collaborate with other departments on Utilization Management Operations.
- Lead key projects and drive initiatives to successful completion.
- Compliance with all applicable laws and regulations.
Requirements:
- Board certification as an MD or DO with a current unrestricted license to practice medicine.
- 3+ years of clinical practice.
- 2+ years of utilization review experience in a managed care plan.
Bonus points:
- Licensure in multiple Oscar states.
- Experience with care management within the health insurance industry.
- Willing and able to obtain additional state licensure as business needs dictate.