Top 1430 Medical director utilization review Jobs

Medical Director
eTeam Inc —Remote
- $170 - $220 an hour
- 8 hour shift
- Remote
- Medicine
- Customer service
- Computer literacy
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Nurse Practitioner/Physician Assistant Sleep Medicine Day Shift Mon - Friday 8am - 5pm
Salem Pulmonary Associates —Salem, OR
- $120,000 - $150,000 a year
- Full-time
- Vital signs
- HIPAA
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Brunswick, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Market Physician Executive (MPE)
Monogram Health Professional Services —Valdosta, GA
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
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Sr. Director of Behavioral Health Services
Bridgeway —Galesburg, IL
- $90,000 - $110,000 a year
- LMFT
- Licensed Clinical Social Worker
- Administrative experience
- Paid holidays
- Health insurance
Quick Apply
PM&R Physician opportunity
Summit Medical Consultants —Colorado Springs, CO
- $250,000 - $300,000 a year
- Full-time
- Medicine
- Skilled nursing facility
- BC/BE
- Mileage reimbursement
- Health insurance
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Team Medical Director
Lynn Community Health Center —Lynn, MA
- $120,000 - $250,000 a year
- Spanish
- Certified Nurse Practitioner
- BC/BE
- Health insurance
- Dental insurance
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Medical Director Psychiatrist
Newport Healthcare —Saint Cloud, MN
- $350,000 - $425,000 a year
- Medicine
- Psychiatry
- 5 years
- Loan repayment program
- Disability insurance
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Physician Opportunities
Summit Medical Consultants LLC —Denver, CO
- $275,000 - $300,000 a year
- 8 hour shift
- Medicine
- Skilled nursing facility
- Doctoral degree
- Health savings account
- Relocation assistance
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Director of Clinical Services (RN) Home Health
Adaptive Home Health —Las Vegas, NV
- Full-time
- RN License
- Office
- Ability to lift 50 pounds
- Dental insurance
- Paid time off
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Medical Director-Board Certified in Psychiatry-MD or DO
The Maxis Group —Remote
- $50 - $170 an hour
- Part-time
- Remote
- Background check
- Medicine
- Psychiatry
Quick Apply
Market Physician Executive (MPE) - Float
Monogram Health Professional Services —Georgia
- On call
- Hybrid work
- Medicine
- Critical & Intensive Care
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
Medical Director
Delaware Valley Residential Care —Warminster, PA
- $2,500 - $3,500 a month
- Full-time
- Medicine
- Management
- Doctoral degree
- Health insurance
- Dental insurance
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14d
Nurse Practitioner & Physician Assistant Opportunity
Summit Medical Consultants LLC —Greeley, CO
- $100,000 - $120,000 a year
- 8 hour shift
- Skilled nursing facility
- BLS Certification
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Inpatient/ Primary Care Physician
Kedren Community Health Center Inc —Los Angeles, CA
- $185,000 a year
- On call
- CPR Certification
- Medicine
- BLS Certification
Quick Apply
Care Navigator - Utilization Management (per diem)
P3 Health Partners —Omaha, NE
- $22 - $25 an hour
- Part-time
- Nursing
- Computer literacy
- High school diploma or GED
Quick Apply
Market Physician Executive (MPE) - Savannah, GA
Monogram Health Professional Services —Savannah, GA
- On call
- Medicine
- Critical & Intensive Care
- Travel
- Health insurance
- Dental insurance
Quick Apply
Primary Care Physician - Sanger Place
Telecare Corporation —Sanger, CA
- $140 - $227 an hour
- Part-time
- 18 years or older
- CPR Certification
- Medicine
Quick Apply
Medical Director (Psychiatrist)
Rutland Mental Health Service, Inc. —Rutland, VT
- $325,000 a year
- Full-time
- Medicine
- Psychiatry
- BC/BE
- Dental insurance
- Tuition reimbursement
Quick Apply
Medical Director - Experienced Forensic Psychiatrist
Annashae —Sparta, IL
- From $41,600 a month
- Contract
- Background check
- Medicine
- Psychiatry
Quick Apply

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Medical Director

eTeam Inc
Remote

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Job Details

Contract
$170 - $220 an hour

Qualifications

Computer operation
Direct patient care
Teamwork
Phone communication
Customer service
BC/BE
Public Health
Medical License
Computer skills
Business Administration
Healthcare software applications
Hospital experience

Full Job Description

ET_RV01
Title: Medical Director (Active medical state licensure required for PA, NY, or WV)
Duration: 6 Months Contract to Hire
Location: (Remote Role) Medical Director Job Description

This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members.

Responsibilities:

Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for members and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.
Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.
Participate in protocol and guidelines development to ensure consistency in the review process.
Actively manage projects and/or participate on project teams that require a physician subject matter expert.
Other duties as assigned .

Required Qualifications:

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
Medical Doctor or Doctor of Osteopathic Medicine (DO)
Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
Active medical state licensure required for PA, NY, or WV.
Critical Thinking
Case Management
Customer Service
Oral & Written Communication Skills
Collaboration
Listening
Telephone Skills
General Computer Skills
Clinical Software
Managed Care

Preferred Qualifications:

Master's Degree in Business Administration/Management or Public Health
1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
Experience with ClientG or InterQual
The expectation is resources will be able to complete 55+ cases in an 8 hour day.
They use two systems for reviews: Predictal and Beacon.
Please categorize your candidates as either Behavioral Health or Non Behavioral Health (Physical Health) in the submit form. This team needs 10-11 to support Non Behavioral Health and 1-2 for Behavioral Health
Manager’s feedback: the candidates they’ve interviewed thus far have not had as much experience (if any) in the UM area from the payer side. Most have just had UM experience on the hospital side which unfortunately is not the same as doing it from the health insurance side.Individuals who have started as a Medical Director or those who accepted/accept offers may choose to obtain malpractice insurance. While this is not a requirement, some physicians prefer to secure coverage before practicing. If they have not yet started, we recommend obtaining this coverage prior to Day 1 if they prefer to have it in place. Should you elect to do so, the cost of the insurance will be your personal responsibility and will not be reimbursed. There is no min required for malpractice insurance as it is not a requirement.

Pay: $170.00 - $220.00 per hour

Work Location: Remote

Quick Apply

Refine Your Search

medical director utilization review jobs

Medical Director

Nurse Practitioner/Physician Assistant Sleep Medicine Day Shift Mon - Friday 8am - 5pm

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Medical Director Psychiatrist

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Director of Clinical Services (RN) Home Health

Medical Director-Board Certified in Psychiatry-MD or DO

Market Physician Executive (MPE) - Float

Medical Director

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Inpatient/ Primary Care Physician

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Market Physician Executive (MPE) - Savannah, GA

Primary Care Physician - Sanger Place

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Medical Director - Experienced Forensic Psychiatrist

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