Medical Director, Utilization & Case Management

choa; Atlanta (GA); On-site; USD 250,000 - 350,000; Full time

Job summary

Children’s Healthcare of Atlanta seeks a Medical Director to provide administrative leadership across Utilization/Case Management, Patient Access, Financial Services, Coding and Compliance for the managed care reimbursement and appeal process.

The physician will partner with case management to support safe, timely discharges and uphold high standards of medical necessity review and denial management. Board certified, Georgia-licensed, with DEA and pediatric credentials, is required.

Qualifications

• Five years’ clinical hospital experience or equivalent.
• Board certified and Georgia license to practice medicine.
• Current DEA registration.
• Meets credentialing requirements for CHOA Professional Staff.

Responsibilities

• Clarify medical necessity criteria for admission with Utilization Management staff.
• Facilitate secondary review when clinical plans are in question.
• Liaise with medical staff to ensure proper reimbursement for managed care patients.
• Educate physicians on precertification, UR roles, and denial trends.
• Lead UM Committee and participate in Medicaid steering and joint operations meetings.
• Support case management to ensure safe, timely, and efficient discharges.

Skills

Communication skills

Time management

Teamwork

Education

MD degree

Pediatric residency

Job description

Children’s Healthcare of Atlanta seeks a Medical Director to provide administrative leadership across Utilization/Case Management, Patient Access, Financial Services, Coding and Compliance for the managed care reimbursement and appeal process.

The physician will partner with case management to support safe, timely discharges and uphold high standards of medical necessity review and denial management. Board certified, Georgia-licensed, with DEA and pediatric credentials, is required.