Physician Medical Director

MHMDAA; United States; Híbrido; USD 180.000 - 280.000; Tempo integral

Resumo da vaga

MHMDAA is seeking a Physician Medical Director to provide high-level clinical advocacy to hospitals nationwide, partnering with payer medical directors to overturn denials and ensure appropriate patient status determinations. This full-time remote role blends clinical leadership with strategic negotiation to improve admission approval rates and maximize revenue recovery.

The ideal candidate is board-certified with at least five years of clinical practice and familiarity with utilization

Qualificações

• Board-certified physician in a medical specialty.
• Minimum 5 years of clinical practice experience.
• Strong knowledge of Milliman, InterQual, and national coverage criteria.
• Excellent communication and negotiation skills.
• Licensed to practice in at least one US state.
• Experience with utilization management or payer relations preferred.

Responsabilidades

• Conduct forensic clinical reviews of patient records and status determinations.
• Lead Peer-to-Peer consultations with payer medical directors.
• Advocate for hospitals by challenging denials using evidence-based criteria.
• Draft Clinical Advocacy Notes for legal and compliance records.
• Collaborate with utilization management teams to optimize clinical workflows.

Conhecimentos

Board certification

Clinical experience 5+ years

Milliman knowledge

InterQual knowledge

Negotiation

Payer relations

Licensed in US state

Formação

MD/DO

Ferramentas

Milliman software

InterQual system

Utilization management systems

Descrição da vaga

Clinical Operations Full-time Remote / National

We are seeking a Physician Medical Director to join our physician-led team. In this role, you will provide high-level clinical advocacy to hospitals nationwide, working directly with payer medical directors to overturn denials and ensure appropriate patient status determinations.

What You Will Do

Conduct forensic clinical reviews of patient records and status determinations

Lead Peer-to-Peer (P2P) consultations with payer medical directors

Advocate for hospitals by challenging inappropriate denials using evidence-based criteria

Draft comprehensive Clinical Advocacy Notes for legal and compliance records

Collaborate with utilization management teams to optimize clinical workflows

Impact

Your work will directly contribute to raising hospital admission approval rates and recovering revenue lost to inappropriate payer denials. This is a role where clinical expertise meets advocacy at scale.

Requirements & Qualifications

• Board certification in a medical specialty (Medicine, Surgery, Cardiology, Pediatrics, etc.)
• Minimum 5 years of clinical practice experience
• Strong working knowledge of Milliman, InterQual, and national coverage criteria
• Excellent communication and negotiation skills
• Experience with utilization management or payer relations preferred
• Licensed to practice medicine in at least one U.S. state