Inpatient Care Management Medical Director - Remote

Lensa; Houston (TX); Remote; USD 200,000 - 250,000; Full time

Job summary

A leading healthcare company seeks an Inpatient Care Management Medical Director to oversee acute care reviews and collaborate with clinical teams. This remote role focuses on managing inpatient care utilization and ensuring quality standards across various client plans, including Medicare and Medicaid.

Qualifications

• At least 3 years of clinical practice experience post-residency.
• Technical proficiency with healthcare software and systems.

Responsibilities

• Conduct acute care and length of stay reviews for medical necessity.
• Collaborate with nurses and support staff to manage inpatient care utilization.
• Participate in telephonic outreach with treating providers.

Skills

Clinical Practice

Evidence-Based Medicine

Healthcare Software Proficiency

Education

MD or DO

Board Certification

Tools

InterQual

Job description

Inpatient Care Management Medical Director - Remote

We are seeking an Inpatient Care Management Medical Director to join our Optum team. This role involves conducting acute care and length of stay reviews for medical necessity across various client plans, including local and national commercial, Medicare, and Medicaid.

The Medical Director will collaborate with nurses and support staff to manage inpatient care utilization at hospital, market, regional, or national levels, working remotely from anywhere in the U.S.

Primary Responsibilities

1. Participate in telephonic outreach with treating providers to discuss evidence-based guidelines, close clinical quality gaps, and modify care plans to impact healthcare expenses.
2. Collaborate with operational and business partners on clinical and quality initiatives to meet customer expectations.
3. Apply evidence-based medicine (EBM) principles using guidelines such as InterQual.
4. Participate in market oversight meetings with senior leaders and external partners as needed.
5. Maintain proficiency in required software and platforms.

Minimum Qualifications

• MD or DO with an active, unrestricted medical license.
• Board Certification in an ABMS or AOBMS specialty.
• At least 3 years of clinical practice experience post-residency.
• Home office setup with high-speed internet.
• Technical proficiency with healthcare software and systems.

Preferred Qualifications

• Licensure in HI, AK, OR, ID, WA, or UT is a plus.
• 2+ years in managed care, quality management, or administrative leadership.
• Prior utilization management experience.
• Clinical practice within the past 2 years.

Additional details include salary ranges for specific states, benefits, and commitment to diversity and health equity. The role offers flexibility to work remotely within the U.S. and involves participation in ongoing program modifications and quality initiatives.