Remote Assistant Medical Director: Clinical Policy & Care

Premera; Washington; Remote; USD 215,000 - 386,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401K employer match

Tuition assistance

Paid time off

Wellness programs

Job summary

Premera seeks an Assistant Medical Director for a work-from-home role, focused on benefit coverage determinations based on medical necessity and contractual language for health plan members. The position supports clinical programs and the development of review criteria, operating PST hours with occasional weekend coverage.

Qualified candidates have an MD/DO, unrestricted WA licensure (or within 90 days), and at least five years of clinical experience with board certification.

Qualifications

• Physician license with an MD or DO degree.
• Unrestricted Washington state licensure or administrative license or ability to obtain within 90 days.
• Five (5) years of clinical experience.
• Current board certification from the American Board of Medical Specialties, or the American Osteopathic Association, or other recognized Association acceptable to Premera.

Responsibilities

• Make final coverage determinations based on medical necessity and contract language.
• Support clinical programs such as disease management and care transitions.
• Engage in peer-to-peer discussions with external physicians.
• Develop and review medical review criteria in collaboration with the Medical Policy Committee.

Skills

Clinical review

Medical policy

Communication with physicians

Education

MD/DO degree

Washington licensure within 90 days

Tools

MCG

InterQual

CPT/ICD coding

Job description

Premera seeks an Assistant Medical Director for a work-from-home role, focused on benefit coverage determinations based on medical necessity and contractual language for health plan members. The position supports clinical programs and the development of review criteria, operating PST hours with occasional weekend coverage.

Qualified candidates have an MD/DO, unrestricted WA licensure (or within 90 days), and at least five years of clinical experience with board certification.