Physician​/Medical Director

Integrated Resources, Inc ( IRI ) provided pay range

This range is provided by Integrated Resources, Inc ( IRI ). Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$140.00/hr - $142.00/hr

Direct message the job poster from Integrated Resources, Inc ( IRI )

Title: Medical Director

Location: REMOTE

Duration: 06+ months (Potential for Hire)

Schedule: 40 hours with rotating weekend coverage; participation in weekend work on a rotational basis to ensure cases are decided in a timely manner.

Schedule is M-F 8 am to 5 PM

Will work on weekends (Saturday and Sunday) once in 3 months.

• The Medical Director’s work includes reviewing all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.
• They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations.
• Medical directors are expected to understand Company processes with a focus on collaborative professional relationships.
• The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and en Product working in a team-based environment. Medical Directors support Company value throughout all activities.

• The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Company policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate en Products working in a structured environment with expectations for consistency in thinking and authorship.
  
  Exercises independence in meeting departmental expectations and meets compliance timelines.
• Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
• Maintain accountability for productivity, quality, and compliance metrics
• Communicate determinations clearly both verbally and in writing
• Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.

• MD or DO degree
• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or > 65 years of age).
• Current and ongoing Board Certification an approved ABMS Medical Specialty
• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
• No current sanctions from Federal or State Governmental organizations, and able to pass credentialing requirements.
• Excellent verbal and written communication skills.
• Evidence of analytic and interpretation skills, with prior experience working in a team environment

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
• Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
• Experience with national guidelines such as MCG® or Inter Qual
• Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical…