We are in search of an Associate Medical Director with a background as a Board Certified Molecular Genetics Physician or Board Certified Pediatrician with Molecular Genetics or Board Certified in Pathology with Molecular Genetics Background. The qualified candidate should have a strong background in Genetics testing or perhaps working in a lab as a Pathologist.
This is an ideal opportunity for a physician who is at the end of their 3rd or 4th quarter of their career who no longer wants to be working in surgery or a physician office, but rather from home offering work/life balance and no on call responsibilities. This job affords you the opportunity to use all of your medical expertise in an effort to produce better outcomes for patients.
Our client is a national corporation who services the needs of the largest health plan providers in the country doing chart/ utilization review of new cases, appealed cases, or reconsiderations (which may be peer-to-peer calls). About 65% of the role involves peer to peer calls.
Here is a bit of what you would be doing in this role:
- Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
- Review appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
- Provide timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
- Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
- Maintains files of all reviews as required by law and Health Plans to retrieve reportable data.
If hired, you will be assigned a mentor to answer any and all questions you may have as you are getting underway in your role. There is quite a bit of support to help you be successful
To be considered you should have an active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine and knowledge of applicable state and federal laws, URAC and NCQA standards. Familiarity with automated processes and computer applications and systems also required. Must have a minimum of five (5) years of clinical practice experience.
You must be board certified through the ABMS.
We are considering those for full time or part time. The hours can be somewhat flexible, but typically are 8a-5p.
Full time is 40 hours a week and includes a full comprehensive benefits package. Full time salary for this role is $ 215,000
Salary : $215,000 – $215,000