Medical Director: Utilization & Outcomes Lead

Integrated Resources, Inc ( IRI ); United States; Hybrid; USD 192,864 - 195,619; Full time

Job summary

A healthcare solutions provider is seeking a Medical Director to oversee clinical review processes, ensuring compliance with national guidelines and quality standards. The ideal candidate will have an MD or DO degree and 5+ years of experience in clinical settings, preferably dealing with a Medicare population. Responsibilities include conducting comprehensive medical necessity reviews and effectively communicating findings to stakeholders. This role offers a pay range of $140.00/hr to $142.00/hr and fosters collaborative professional relationships.

Qualifications

• 5+ years of direct clinical patient care experience post residency or fellowship.
• Experience in an inpatient environment or with a Medicare population is preferred.
• Knowledge of managed care including Medicare Advantage or Managed Medicaid is a plus.

Responsibilities

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

Skills

Excellent verbal and written communication skills

Analytic and interpretation skills

Flexibility to adapt to dynamic changes

Education

MD or DO degree

Current and ongoing Board Certification

Current and unrestricted medical license

Job description

A healthcare solutions provider is seeking a Medical Director to oversee clinical review processes, ensuring compliance with national guidelines and quality standards. The ideal candidate will have an MD or DO degree and 5+ years of experience in clinical settings, preferably dealing with a Medicare population. Responsibilities include conducting comprehensive medical necessity reviews and effectively communicating findings to stakeholders. This role offers a pay range of $140.00/hr to $142.00/hr and fosters collaborative professional relationships.