Medical Director

Job description

Medical Director
Remote, USA
Competitive Salary

The Medical Director is essential in assessing clinical data, analyzing medical records, and making informed decisions about requested healthcare services. Responsibilities encompass conducting comprehensive clinical evaluations, integrating complex inpatient and outpatient cases, and collaborating with external providers to obtain further information as necessary. This position demands exceptional clinical judgment, professionalism, and effective teamwork. The role offers advantages such as regular weekend schedules, a focus on non-clinical responsibilities, contract-to-hire options for stability, a feature of no patient complaints or RVUs, and well-defined processes along with decision-making guidelines.

Key Responsibilities of the Medical Director

• Conduct prompt and compliant reviews of medical necessity for inpatient or related clinical services.
• Utilize national clinical benchmarks, regulatory criteria, internal procedures, and clinical standards to evaluate the appropriateness of services.
• Articulate decisions clearly and professionally, both verbally and in written forms.
• Engage in clinical conversations with external providers to clarify details and rationales for decisions.
• Ensure strong performance across metrics related to productivity, quality, and compliance.
• Operate independently following structured onboarding while consulting with colleagues when necessary.
• Adapt to shifting workflows, tools, and utilization management strategies.
• Promote a culture of cooperation, consistency, and superior clinical decision-making.

Qualifications for the Medical Director

• MD or DO degree required.
• At least 5 years of experience in direct patient care post-residency or fellowship, preferably with experience in inpatient settings or managing adult/geriatric populations.
• Current board certification in a specialty recognized by the ABMS.
• Active, unrestricted medical license in at least one U.S. jurisdiction, with readiness to seek additional licensure if necessary.
• No existing sanctions and ability to fulfill credentialing requirements.
• Excellent verbal and written communication capabilities.
• Proven analytical skills and ability to work collaboratively within multidisciplinary teams.

Preferred Qualifications for the Medical Director

• Experience in managed care, clinical assessment, utilization management, or health plan operations.
• Knowledge of clinical review standards (e.g., InterQual, MCG).
• Background in hospital-based specialties like Internal Medicine, Family Medicine, Geriatrics, Hospitalist Medicine, Emergency Medicine, or related areas.
• Ability to work effectively in fast-paced, highly regulated environments.
• Comfort with technology that enhances workflow efficiency.
• Dedication to ongoing education, adaptability, and improvements in processes.
• Interest in contributing to training or educational programs within the organization.

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