Medical Director

Job description

Medical Director
Remote, USA
Competitive Pay

The position of Medical Director is integral in the assessment of clinical data, the interpretation of medical histories, and the formulation of informed decisions regarding healthcare service requests. Responsibilities include executing in-depth clinical evaluations, interpreting complex scenarios involving both inpatient and outpatient care, and liaising with external healthcare providers for additional insights when necessary. This role demands excellent clinical judgment, high professionalism, and robust teamwork skills. Benefits include predictable weekends, a non-clinical workload, the stability of a contract-to-hire arrangement, absence of patient complaints or RVUs, and well-defined structures and decision-making guidelines.

Key Responsibilities:

• Conduct prompt and compliant medical necessity assessments for clinical services related to inpatient care
• Utilize national clinical guidelines, regulations, internal policies, and accepted clinical standards to evaluate service appropriateness
• Effectively communicate decisions both verbally and in writing with clarity and professionalism
• Engage in clinical dialogues with external providers to refine information and elucidate decisions
• Maintain excellent performance on metrics related to productivity, quality, and compliance
• Operate independently following structured onboarding, while collaborating with team members when needed
• Adjust to changing workflows, tools, and management practices for utilization
• Promote a collaborative environment that fosters consistency and high-quality clinical decision-making

Qualifications:

• Medical Doctor (MD) or Doctor of Osteopathy (DO)
• At least 5 years of direct patient care experience post-residency or fellowship, ideally with inpatient-related exposure or care for adult and older adult populations
• Current board certification in a specialty recognized by the American Board of Medical Specialties (ABMS)
• Active, unrestricted medical license in at least one U.S. state, with a readiness to obtain further licensure if required
• No active sanctions and able to fulfill all credentialing criteria
• Excellent written and verbal communication abilities
• Proven analytical skills, with experience collaborating in multidisciplinary teams

Preferred Qualifications:

• Experience in managed care, clinical reviews, utilization management, or operations within a health plan
• Familiarity with clinical review standards such as InterQual or MCG
• Background in hospital-focused specialties like Internal Medicine, Family Medicine, Geriatrics, Hospitalist Medicine, Emergency Medicine, or similar areas
• Aptitude for thriving in high-pressure, regulatory environments
• Proficiency in utilizing technology to enhance workflow efficiency
• Dedication to ongoing learning, flexibility, and improvement of processes
• Enthusiasm for participating in training or educational programs within the organization