Description
The Medical Director role involves reviewing health claims and making utilisation management determinations. You will perform expert clinical reviews of inpatient medical records, assessing medical necessity based on national guidelines, CMS regulations, and recognised clinical standards.
Responsibilities:
- Conduct inpatient medical necessity reviews promptly and in accordance with regulatory requirements.
- Uphold excellence in productivity, accuracy, quality, and timely completion of assigned tasks.
- Communicate review outcomes clearly and professionally in both verbal and written formats.
- Demonstrate flexibility and adaptability to changing workflows, tools, and utilisation management procedures.
Requirements:
- MD or DO
- 5 or more years post-residency clinical experience
- Active, unrestricted medical license in at least one state and willingness to obtain additional licenses as needed
- Current and ongoing Board Certification in an AOABPS- or ABMS-recognised medical specialty
- Strong analytical, communication, and documentation skills
Preferred Qualifications:
- Inpatient exposure (hospitalist-level acuity, ED, ICU, or hospital-based FP/IM)
- Prior experience in utilisation management or inpatient review
- Familiarity with MCG or InterQual guidelines
Additional Information:
- Reports directly to a Lead Medical Director
- Standard work hours are Monday through Friday 8am-5pm local time, with rotational weekend/holiday coverage (approx. 5 weekends per year)
- May participate in organisational committees or special project teams
Benefits:
- Competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and short-term and long-term disability