Assistant Medical Director

Medical Mutual; Brooklyn (OH); Remote; USD 150,000 - 200,000; Full time

Job summary

Join a pioneering health insurance company as an Assistant Medical Director, where your clinical expertise will shape the future of care management. In this role, you will provide essential guidance in utilization review, ensuring that our members receive the most effective medical care. With a focus on evidence-based medicine and a commitment to quality, you will collaborate with a dedicated team to enhance our clinical policies and practices. This position offers the flexibility of remote work, making it an excellent opportunity for those seeking to make a significant impact in a supportive and innovative environment. If you are passionate about healthcare and ready to lead, this role is for you.

Qualifications

• 5+ years of clinical care practice experience required.
• Board Certification in a nationally recognized specialty is required.

Responsibilities

• Provides clinical expertise to the utilization review process.
• Ensures compliance with clinical goals through monitoring performance.

Skills

Clinical expertise

Utilization review

Evidence-based medicine

Case management coordination

Education

Doctor of Medicine (MD)

Doctor of Osteopathic Medicine (DO)

Tools

Windows-based computer skills

Job description

Job Description - Assistant Medical Director (2500024)

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans.

This position has the option to work fully remote; Ohio residents preferred. Medicare experience preferred.

Responsibilities

• Provides clinical expertise to the utilization review process and determinations.
• Provides pre-determination reviews and reviews of claims determinations, providing clinical, coding and reimbursement expertise.
• Ensures compliance with clinical goals through monitoring of care management performance.
• Ensures the appropriate and most cost-effective medical care is received.
• Recommends changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
• Assists in development and interpretation of medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.
• Provides guidance to case management team in the coordination of quality care.
• Performs other duties as assigned.

Qualifications

Education and Experience

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school.
• Minimum of 5 years of established (clinical) care practice experience required.
• Physician reviewer experience in the insurance industry preferred.

Professional Certification(s)

• Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
• Active unrestricted license to practice medicine in U.S. state of residency.

Technical Skills and Knowledge

• Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
• Strong understanding of integration of evidence-based medicine and managed care principles.
• Knowledge of health plan claims adjudication and utilization review processes preferred.

About Medical Mutual

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders. We focus on developing products and services that allow us to better serve our customers and the communities around us.

We’re proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer.