Here is a bit of what you would be doing in this role:
Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
Review appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
Provide timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
Maintains files of all reviews as required by law and Health Plans to retrieve reportable data.
If hired, you will be assigned a mentor to answer any and all questions you may have as you are getting underway in your role. There is quite a bit of support to help you be successful
We are in search of an Associate Medical Director with a background as a Board Certified Orthopedic Surgeon with Spine and/or Large Joint Surgery experience such as Shoulder, Knee and Hip. It is a requirement you have completed a SPINE FELLOWSHIP
This is an ideal opportunity for a physician who is at the end of their 3rd or 4th quarter of their career who no longer wants to be working in surgery or a physician office, but rather from home offering work/life balance and no on call responsibilities. This job affords you the opportunity to use all of your medical expertise in an effort to produce better outcomes for patients. This is a remote opportunity.
Our client is a national corporation who services the needs of the largest health plan providers in the country doing chart/utilization review of new cases, appealed cases, or reconsiderations (which may be peer-to-peer calls).
This role will have you working with the Radiology/Imaging Department. What this means is you will be seeing Ortho Surgery cases, but not strictly Ortho Surgery throughout the year. You will be asked occasionally to see imaging cases. Interested physicians must be open and flexible to both. The MD will have our evidence based guidelines to lean on for cases outside of their specialty.
To be considered you should have an active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine and knowledge of applicable state and federal laws, URAC and NCQA standards. Familiarity with automated processes and computer applications and systems also required. Must have a minimum of five (5) years of clinical practice experience.
You must be board certified through the ABMS. It is NOT required for you to be licensed in any state.
We are considering those interested in working full time.
Full time hours are considered anything between 30-40 hours per week and would be SET daily schedule from 8a-5p.
Full time is 40 hours a week and includes a full comprehensive benefits package. Full time salary for this role is $ 245,000.
For those considering working Part Time Part time
- Part time is considered anything between 20-30 hours per week. For part time, the salary is prorated, based on the number of hours worked. There is some flexibility with the schedule, but it must be at least 4 hours per day and the days must include a Monday and a Friday. As the candidate works through the final stages of the interview process, you would be scheduled with our scheduling department to discuss schedule.
To learn more about this unique remote opportunity, please email your resume along with the best days and times to reach you.
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