Position Details
About this role
This role involves reviewing health claims, providing medical interpretation, and making decisions on the appropriateness of services in a remote setting. The Medical Director ensures compliance and supports care coordination for Medicare and Medicaid populations.
Key Responsibilities
- Review health claims
- Provide medical interpretation
- Ensure compliance with policies
- Participate in care coordination teams
- Support quality assurance initiatives
Technical Overview
The position requires expertise in clinical care, utilization management, and healthcare analytics, with familiarity in Medicare Advantage, Managed Medicaid, and clinical guidelines like InterQual and MCG.
Ideal Candidate
The ideal candidate is a mid-level healthcare professional with an MD or DO, board certification, and 3+ years of clinical experience, especially in transitions of care and utilization management. They possess strong analytical skills and are capable of working autonomously in a remote setting.
Must-Have Skills
Nice-to-Have Skills
Required Skills
Hard Skills
Soft Skills
Certifications
Required
Industry & Role
Keywords for Your Resume
Deal Breakers
No medical license, Lack of board certification, Less than 3 years of clinical experience, Inability to pass credentialing, No experience in utilization management
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