State Licensed Medical Director

Job Summary

To optimize the use of institutional and outpatient services, the full-time State Licensed Medical Director in Utilization Management will conduct clinical reviews for medical necessity and treatment appropriateness while working remotely across the U.S.

Key responsibilities

• Conduct second-level reviews in compliance with Medicare/CMS guidelines for various levels of care
• Act as a liaison between medical staff and third-party payers to ensure appropriate levels of medical care
• Oversee UM clinical staff and collaborate with interdisciplinary teams to develop utilization management protocols

Required qualifications

• 3-5 years of experience in clinical care, quality management, or utilization and case management
• Completion of medical school and specialty residency, preferably in internal medicine
• Board certification and current, non-restricted licensure for clinical practice
• Preferred experience as a Physician Advisor
• Knowledge of healthcare delivery systems and financial/reimbursement issues