Remote Medical Director — Clinical Excellence & Utilization

Superior Dental Care, Inc.; North Olmsted (OH); Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Laptop provided

Gym membership reimbursement

On-site cafeteria (Brooklyn, OH)

Job summary

Medical Mutual, the Ohio-based health insurer, is seeking a physician reviewer to support the utilization review process and determinations across inpatient and outpatient care.

This remote-based role requires an MD or DO, minimum 5 years of clinical practice, and board certification; an unrestricted U.S. license is required. Medical Mutual offers a comprehensive benefits package and a supportive, inclusive culture.

Qualifications

• MD/DO from an accredited medical school.
• Minimum of 5 years of established clinical care experience.
• Physician reviewer experience in the insurance industry preferred.

Responsibilities

• Participate in utilization review processes and determinations.
• Provide pre-determination reviews and reviews of claims determinations with clinical, coding and reimbursement input.
• Monitor care management performance to ensure compliance with clinical goals.
• Ensure delivery of cost-effective medical care.
• Recommend changes to managed care guidelines and clinical criteria.
• Develop and interpret medical policy and guidelines.
• Guide case management in coordinating quality care.
• Perform other duties as assigned.

Skills

Typing

Word processing

Presentations

Internet research

Evidence-based medicine

Managed care principles

Education

MD or DO degree

Job description

Medical Mutual, the Ohio-based health insurer, is seeking a physician reviewer to support the utilization review process and determinations across inpatient and outpatient care.

This remote-based role requires an MD or DO, minimum 5 years of clinical practice, and board certification; an unrestricted U.S. license is required. Medical Mutual offers a comprehensive benefits package and a supportive, inclusive culture.