Physician/Medical Director

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

Job summary

A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making. This role demands a blend of clinical experience, leadership, and the ability to guide a team while ensuring compliance with national guidelines and company policies. Ideal candidates will have significant clinical experience, an MD or DO degree, and a passion for quality in healthcare. The position offers a contract employment type and requires working 40 hours a week with some weekend coverage.

Qualifications

• 5+ years of direct clinical patient care experience post residency or fellowship.
• Current and unrestricted medical license.
• No current sanctions from governmental organizations.

Responsibilities

• Provide medical interpretation and determinations for services.
• Conduct medical necessity reviews for inpatient services.
• Communicate determinations clearly both verbally and in writing.

Skills

Excellent verbal and written communication skills

Analytic and interpretation skills

Education

MD or DO degree

Board Certification in an approved ABMS Medical Specialty

Job description

Integrated Resources, Inc ( IRI ) provided pay range

This range is provided by Integrated Resources, Inc ( IRI ). Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$140.00/hr - $142.00/hr

Direct message the job poster from Integrated Resources, Inc ( IRI )

Lead Recruiter at Integrated Resources Inc.

Title: Medical Director

Location: REMOTE

Duration: 06+ months (Potential for Hire)

Schedule: 40 hours with rotating weekend coverage; participation in weekend work on a rotational basis to ensure cases are decided in a timely manner.

Schedule is M-F 8 am to 5 PM

Will work on weekends (Saturday and Sunday) once in 3 months.

Job Description

• The Medical Director’s work includes reviewing all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.
• They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations.
• Medical directors are expected to understand Company processes with a focus on collaborative professional relationships.
• The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enProduct working in a team-based environment. Medical Directors support Company value throughout all activities.

Responsibilities

• The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Company policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enProducts working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
• Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
• Maintain accountability for productivity, quality, and compliance metrics
• Communicate determinations clearly both verbally and in writing
• Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.

Required Qualifications

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or > 65 years of age).
• Current and ongoing Board Certification an approved ABMS Medical Specialty
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
• No current sanctions from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience working in a team environment

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
• Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
• Experience with national guidelines such as MCG® or InterQual
• Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists
• The curiosity to learn and the flexibility to adapt to changes to enhance efficiency, productivity, and organizational goals.
• Ability to thrive in a dynamic, fast-paced, team-oriented environment.
• Commitment to a culture of innovation, including being facile with using technology to improve workflows
• Participate in educational activities by attending required conferences and create content to lead/teach/present for individual subject matter contribution
• Passionate about contributing to an organization’s focus on consistency in outcomes, consumer experiences and a highly engaged team culture

Seniority level

• Director

Employment type

• Contract

Job function

• Science, Health Care Provider, and Research
• Hospitals and Health Care, Health and Human Services, and Insurance

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