Medical Director

CTC; United States; On-site; USD 200,000 - 300,000; Full time

Job summary

A healthcare organization in the United States is seeking a Medical Director responsible for reviewing medical records and making expert decisions on requested services. The ideal candidate should possess an MD or DO degree, at least 5 years of clinical experience, and hold current Board Certification. Responsibilities include conducting medical necessity reviews, maintaining compliance metrics, and communicating decisions effectively. This role requires strong analytical skills and the ability to thrive in a fast-paced team-oriented environment.

Qualifications

• 5+ years of direct clinical patient care experience, preferably in inpatient environments.
• Knowledge of managed care industry including Medicare Advantage.
• Experience with national guidelines such as MCG® or InterQual.

Responsibilities

• Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services.
• Maintain accountability for productivity, quality, and compliance metrics.
• Communicate determinations clearly both verbally and in writing.

Skills

Excellent verbal and written communication skills

Analytic and interpretation skills

Ability to thrive in a dynamic fast-paced environment

Teamwork in a structured environment

Education

MD or DO degree

Current and ongoing Board Certification

Current and unrestricted medical license

Job description

Schedule

40 hours with rotating weekend coverage; participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner.

Description

The Medical Director’s work includes reviewing all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support value throughout all activities.

Responsibilities

The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.

• Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
• Maintain accountability for productivity, quality, and compliance metrics
• Communicate determinations clearly both verbally and in writing
• Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices

Required Qualifications

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
• Current and ongoing Board Certification an approved ABMS Medical Specialty
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience working in a team environment

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
• Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
• Experience with national guidelines such as MCG® or InterQual
• Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists
• The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
• Ability to thrive in a dynamic fast-paced, team-oriented environment.
• Commitment to a culture of innovation, including being facile with using technology to improve workflows
• Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
• Passionate about contributing to an organization’s focus on consistency in outcomes, consumer experiences and a highly engaged team culture