Assistant Medical Director

** Medical Mutual employees must submit their applications through MySource.**

** This is a remote-based role, and we are currently seeking candidates located in Ohio.**

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Provides clinical expertise to promote the delivery of high quality, cost effective, (member centric) medical care. Contributes to the achievement of clinical excellence; quality ratings improvement, appropriate inpatient and outpatient utilization, affordability, compliance, growth and focused improvement, and that initiatives are consistently implemented and successfully executed to achieve goals.

• Provides clinical expertise to the utilization review process and determinations.
• Provides pre-determination reviews and reviews of claims determinations, providing clinical, coding and reimbursement expertise.
• Ensures compliance with clinical goals through monitoring of care management performance.
• Ensures the appropriate and most cost-effective medical care is received.
• Recommends changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
• Assists in development and interpretation of medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.
• Provides guidance to case management team in the coordination of quality care.
• Performs other duties as assigned.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school.
• Minimum of 5 years of established (clinical) care practice experience required.
• Physician reviewer experience in the insurance industry preferred.

• Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
• Active unrestricted license to practice medicine in U.S state of residency.

• Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
• Strong understanding of integration of evidence-based medicine and managed care principles.
• Knowledge of health plan claims adjudication and utilization review processes preferred.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and…