Medical Director

Overview

The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Required skills & experience (the “must haves” to be considered) - MD or DO degree - Board Certified in an approved ABMS Medical Specialty - Excellent communication skills with 5 years of established clinical experience - Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products - A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment - Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab - Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists, preferred What you need to know - Amazing work from home opportunity allowing for work/life balance while still using your license - M-F, 8-5 schedule with weekend call every 5 weeks or so. No night-time call - Will cover territory comprised of states in the Atlantic, but candidates can reside anywhere in the US - Opportunity to work for a Fortune 100 company with fantastic culture, compensation and benefits

Benefits

Company

For more than 50 years we have been a proven leader and innovator in the health and wellness industry. A passionate emphasis on people, choice, well-being, and innovation guide our business practices and culture. We’re not just a health insurance company. Our diverse lines of business position us to serve millions of people with a wide range of needs, including seniors, military members, and self-employed individuals.