Remote Medical Director: Utilization Management

CAI; Olympia (WA); Remoto; USD 234.000 - 276.000; Tempo pieno

Descrizione del lavoro

CAI is a global services firm seeking a Medical Director to ensure utilization management meets the highest clinical standards. The position is full-time and remote, enabling work from home while contributing to critical case reviews and policy development.

The role requires an MD or DO with board certification, active licensure, and at least 5 years of clinical care experience, plus strong communication and managed care skills. Competitive pay and benefits offered.

Competenze

• MD or DO with active state licensure and board certification in a recognized specialty.
• Minimum 5 years of direct clinical patient care experience in hospital, outpatient, or private practice.
• Strong communication, critical thinking, and managed care knowledge.

Mansioni

• Conduct electronic review of escalated cases to determine medical necessity.
• Complete initial determination of cases and review appeals and grievances.
• Draft clear rationales for member/provider notifications in compliance standards.
• Ensure medical management aligns with community standards of care.
• Participate on CMDM multidisciplinary team and advise on physician cases.
• Contribute to protocol and guideline development for review processes.
• Lead or participate in projects requiring physician subject matter expertise.

Conoscenze

Critical Thinking

Case Management

Customer Service

Oral & Written Communication

Collaboration

Listening

Telephone Skills

General Computer Skills

Clinical Software

Managed Care

Formazione

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)

Board Certification by ABMS or AOA

Active medical state licensure (PA, NY, WV)

5 years in Clinical, Direct Patient care

Master's Degree in Business Administration/Management or Public Health

Descrizione del lavoro

CAI is a global services firm seeking a Medical Director to ensure utilization management meets the highest clinical standards. The position is full-time and remote, enabling work from home while contributing to critical case reviews and policy development.

The role requires an MD or DO with board certification, active licensure, and at least 5 years of clinical care experience, plus strong communication and managed care skills. Competitive pay and benefits offered.