PA Licensed Medical Director
Job Summary
To support a growing healthcare practice, the part-time Medical Director will review over 55 cases daily for medical necessity, conduct escalated case reviews, and ensure compliance with regulatory requirements while working remotely on a contract basis.
Key responsibilities
- Review cases using medical policy criteria to determine medical necessity and appropriateness
- Conduct escalated case reviews, appeals, grievances, and peer-to-peer discussions
- Participate in multidisciplinary case management teams and contribute to clinical protocols and guidelines
Required qualifications
- MD or DO with an active PA, NY, or WV medical license (or willingness to obtain before start)
- Board Certified in an ABMS/AOA-recognized specialty
- 5+ years of clinical/direct patient care experience
- Strong payer-side Utilization Management/Medical Management experience preferred
- Experience with MCG or InterQual preferred
Complete Job Description
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