Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote

Lensa; Bloomfield (CT); Remote; USD 203,000 - 339,000; Full time

Job summary

An established industry player is seeking a Medical Director specializing in post-acute care to provide expert medical reviews and clinical opinions. This remote position involves engaging with physicians, conducting case conferences, and supporting clinical guideline development. The ideal candidate will have extensive clinical experience and board certification in Physical Medicine and Rehabilitation. This role offers a competitive salary and comprehensive benefits, making it an excellent opportunity for professionals looking to make a meaningful impact in healthcare.

Benefits

Health Coverage

401(k)

Paid Time Off

Qualifications

• M.D. or D.O. from an accredited institution required.
• Active board certification and unrestricted medical license needed.

Responsibilities

• Review medical necessity requests and provide clinical opinions.
• Conduct weekly case conferences focusing on discharge planning.
• Engage in peer-to-peer discussions with treating physicians.

Skills

Medical Review

Clinical Opinions

Peer Review

Discharge Planning

Quality of Care Management

Education

M.D. or D.O.

Board Certification in Physical Medicine and Rehabilitation

Five years of post-training clinical practice

Job description

Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote

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Summary

The Medical Director provides expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria, offering clinical opinions about the services under review while based in a U.S. state or territory.

Responsibilities Include

• Review medical necessity requests related to post-acute care and provide clinical opinions, including post-decision reviews.
• Engage in peer-to-peer discussions with treating physicians to clarify clinical information and review outcomes.
• Participate in proactive peer reviews for discharge planning.
• Document all clinical review actions and attest to review qualifications.
• Conduct weekly case conferences with nursing and social work teams focusing on discharge planning, complex care management, and quality of care.
• Maintain credentials and report adverse actions regarding medical licenses or certifications.
• Support review and development of clinical guidelines and communicate policies to providers.
• Testify at ALJ hearings during appeals.
• Assist with staff training and serve as a clinical resource.
• Act as a Subject Matter Expert when senior medical directors are unavailable.
• Be available for scheduled weekend calls from home as needed.
• Participate in joint operational meetings and educational activities.
• Review case determinations in response to provider or member complaints.

Minimum Education, Licensure, and Certification

• M.D. or D.O. from an accredited institution.
• At least five years of post-training clinical practice.
• Active board certification in Physical Medicine and Rehabilitation.
• Unrestricted medical license in a U.S. state or territory.
• Knowledge of relevant laws, standards, and utilization management.

Additional Details

FLSA: Exempt
Salary Range: $203,200 - $338,600 annually, based on experience and location
Benefits include health coverage, 401(k), paid time off, and more.
Evernorth Health Services, a division of The Cigna Group, aims to improve health outcomes through innovative pharmacy, care, and benefit solutions.