, Illinois
Job description
Medical Director
Remote, USA
Competitive Pay
The Medical Director is a vital role focused on the assessment of clinical data, analysis of medical records, and delivering expert recommendations related to healthcare services. This position will involve conducting detailed clinical evaluations, integrating complex inpatient and outpatient situations, and directly communicating with external healthcare providers to obtain further details as necessary. The ideal candidate will possess exceptional clinical judgment, professionalism, and a strong ability to work collaboratively in a team-based setting. Benefits include predictable weekends, a non-clinical workload, contract-to-hire stability, absence of patient complaints or RVUs, and well-defined structure and decision-making guidelines.
Key Responsibilities of the Medical Director
- Conduct timely and compliant medical necessity evaluations for inpatient or related clinical services.
- Utilize national clinical standards, regulatory policies, and internal protocols to assess the appropriateness of services.
- Articulate decisions clearly and professionally, both in discussions and written communication.
- Engage in clinical discussions with external providers to clarify information and justify decisions.
- Achieve strong performance in productivity, quality, and compliance metrics.
- Operate independently post-onboarding while consulting with team members as necessary.
- Adapt swiftly to changes in workflows, tools, and utilization management practices.
- Encourage a culture of collaboration and consistency in high-quality clinical decision-making.
Qualifications for the Medical Director
- MD or DO degree required.
- At least 5 years of direct patient care experience post-residency or fellowship, preferably with inpatient exposure or experience with adult/older adult patients.
- Current board certification in an ABMS-recognized specialty.
- Possess an active, unrestricted medical license in at least one U.S. jurisdiction and the willingness to obtain additional licenses if necessary.
- No active sanctions and ability to fulfill credentialing requirements.
- Excellent written and verbal communication skills.
- Proven analytical skills and proficiency in working within multidisciplinary teams.
Preferred Qualifications for the Medical Director
- Previous experience in managed care, clinical review, utilization management, or health plan operations.
- Familiar with clinical review guidelines such as InterQual and MCG.
- Experience in hospital-based specialties including Internal Medicine, Family Medicine, Geriatrics, Hospitalist Medicine, Emergency Medicine, or similar fields.
- Adept at functioning in fast-paced, regulated environments.
- Comfortable using technology to enhance workflow efficiency.
- Dedication to continuous learning, adaptability, and process improvement.
- Interest in contributing to educational or training initiatives within the organization.
