Medical Director

5 days ago

🇺🇸 United States – Remote

⚜️ Louisiana – Remote

Although this job is listed in Louisiana, this company may be open to hiring remote in other states.

🌲 North Carolina – Remote

Although this job is listed in North Carolina, this company may be open to hiring remote in other states.

+3 more states

⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ☕ Washington – Remote

💵 $170k - $342.3k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

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Highmark Health

WebsiteLinkedInAll Job Openings

health care

10,000+ employees

Founded 1852

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

💰 $5M Grant on 2021-05

Description

• This job ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. • The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate medical necessity and appropriateness of requested treatment or service. • Telephonic peer to peer discussions may be required based on case nature. • The incumbent ensures compliance with NCQA, URAC, CMS, DOH, and DOL regulations. • Participates as the physician member of multidisciplinary team for case and disease management. • Advises multidisciplinary team on high-risk cases and manages special projects to improve care for members.

Requirements

• 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) • 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry • Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) • Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards • Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.