Remote Medical Director: Prior Authorization & Care Quality

Virtix Health, LLC.; United States; On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Medical, Dental, Vision coverage

401K plan

CME/licensing allowance

Job summary

Virtix Health, LLC. seeks a Medical Director to lead prior authorization reviews for Medicare beneficiaries in a largely remote role.

The position involves evaluating clinical records to ensure compliance with CMS guidelines, and collaborating with multidisciplinary teams to drive care improvements. Ideal candidates are board-certified physicians with active US licenses and strong knowledge of CMS regulations.

Qualifications

• Board-certified physician (MD or DO) with an active license in at least one US state.
• Specialization in PMR, neurology, pulmonology, urology, or orthopedics preferred.
• Active Medicare/Medicaid participation eligibility.
• State of Washington license preferred or willingness to obtain.

Responsibilities

• Review clinical records and case files to ensure CMS compliance and high standards of care.
• Prepare for and participate in peer-to-peer discussions regarding prior authorization requests.
• Assist in training and development on CMS NCD/LCD guidelines and documentation.
• Provide recommendations to improve clinical practices based on reviews and data analysis.
• Maintain accurate records of reviews, audits and quality improvement efforts.

Skills

Excellent communication

EHR proficiency

CMS regulations

Attention to detail

Fast-paced environment

Education

MD/DO (board-certified)

Active US medical license

Tools

EHR software

CMS guidelines databases

Job description

Virtix Health, LLC. seeks a Medical Director to lead prior authorization reviews for Medicare beneficiaries in a largely remote role.

The position involves evaluating clinical records to ensure compliance with CMS guidelines, and collaborating with multidisciplinary teams to drive care improvements. Ideal candidates are board-certified physicians with active US licenses and strong knowledge of CMS regulations.