Description: Our client is currently seeking a Medical Director
Hi there! I'm glad you found us. Are you looking for a side project that offers the flexibility of working 20 hours per month with the security of potential for hire? We are actively looking to interview physicians with at least three years of experience working with Medicaid plan members in a clinical or administrative setting to act as a Medical Director. This is a fully remote role with potential for temp-to-hire in the future and an increase in hours contingent upon the volume of need.
•Actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines,
state policies, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn WI Medicaid and CMS Medicare requirements and will understand how to operationalize this knowledge in their daily work.
•Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios arise from outpatient, inpatient or post-acute care environments.
•Will have discussions with external physicians by phone to gather additional clinical information or discuss determinations through the Peer 2 Peer process, and in some instances, these may require conflict resolution skills.
•Other duties include, but may not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic testing, etc. within their scope.
I encourage all interested and qualified physicians to forward their resumes to email@example.com for immediate consideration. If this is not a role you are interested in, please still send me your resume as we have rewarding healthcare roles nationwide; there is something for everyone! Thank you for your time and I look forward to hearing about your unique skill set.
Mia Cullen, Recruiter Associate, The Judge Group
151 S. Warner Rd. | Wayne, PA | 19087