Medical Director - Post-Acute Care - EviCore - Remote

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

Job summary

A leading healthcare organization is seeking a Medical Director for Post-Acute Care. This remote role involves expert medical reviews, peer discussions, and maintaining clinical guidelines. Candidates must hold an M.D. or D.O. degree and have extensive clinical experience. The position offers a competitive salary and benefits, emphasizing diversity and equal opportunity.

Benefits

Health Coverage

401(k)

Paid Time Off

Qualifications

• At least five years of clinical practice post-residency/fellowship.
• Unrestricted medical license in a U.S. state or territory.

Responsibilities

• Provide expert medical review of necessity requests for clinical services.
• Engage in peer-to-peer discussions with treating physicians.
• Conduct weekly case conferences focusing on discharge planning.

Skills

Medical Review

Clinical Opinion

Peer Review

Quality Improvement

Education

M.D. or D.O. degree

Active board certification in Physical Medicine and Rehabilitation

Job description

Medical Director - Post-Acute Care - EviCore - Remote

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Summary

The Medical Director provides timely expert medical review of medical necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about the medical service under review while located in a state or territory of the United States.

Responsibilities Include

• Provide timely expert medical review of medical necessity requests for clinical services related to post-acute care and render a clinical opinion about the medical service under review, including post-decision reviews.
• Engage in peer-to-peer discussions with treating physicians to clarify clinical information and explain review outcomes.
• Participate in proactive peer reviews to assist with discharge planning.
• Document all actions related to clinical reviews and attest to review qualifications as required.
• Conduct weekly case conferences with nursing and social worker teams focusing on discharge planning, complex medical care management, quality of care, and appropriate level of care and stay.
• Maintain necessary credentials and promptly report any adverse actions related to medical licenses or certifications.
• Support the review and development of eviCore clinical guidelines.
• Communicate policies and procedures to the provider community.
• Testify at ALJ Hearings during appeals.
• Assist with staff training and serve as a clinical resource for eviCore staff.
• Serve as a Subject Matter Expert when senior medical directors are unavailable.
• Be available for scheduled weekend calls from home based on business needs.
• Participate in Joint Operating Committee meetings and provider engagement activities.
• Engage in educational and quality improvement activities, maintaining passing scores.
• Review case determinations responding to provider or member complaints.

Minimum Education, Licensure, and Certification

• M.D. or D.O. degree from an accredited institution.
• At least five years of clinical practice post-residency/fellowship.
• 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

Role is exempt, full-time, with a salary range of $203,200 - $338,600 USD/year, plus potential bonuses. Benefits include health coverage, 401(k), paid time off, and more. Candidates must have reliable high-speed internet if working remotely. The position involves participating in meetings, training, and occasional weekend calls. The employer values diversity and equal opportunity. For accommodations, contact [e-mail].