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Associate Medical Director II - REMOTE
NPAworldwide Recruitment Network
NPAworldwide Recruitment Network
 
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Job Location: Houston, TX
JOB DESCRIPTION

Job #: 4969
Title: Associate Medical Director II - REMOTE
Job Location: Houston, Texas - United States
Employment Type:
Salary: $245,000.00 - $245,000.00 - US Dollars - Yearly
Other Compensation: 4% annual bonus, vacation, 401k, PTO, CME credits
Employer Will Recruit From: Nationwide
Anywhere - Remote roles
Relocation Paid?: NO

WHY IS THIS A GREAT OPPORTUNITY?

Job Objectives: To evaluate medical necessity requests for clinical services that do not meet utilization review criteria and render a clinical opinion about the medical service under review. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions. Documents all actions related to clinical review sessions and attests to appeal review qualifications as required


JOB DESCRIPTION

Responsibilities:

  1. Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
  2. Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
  3. Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
  4. Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
  5. Maintains files of all reviews as required by law and Health Plans to retrieve reportable data.
  6. Maintains necessary credentials and immediately informs company of any adverse actions relating to medical licenses and/or board certifications.
  7. Supports the annual review of utilization review criteria.
  8. Supports and communicates company policy and procedures to the provider community.
  9. Participates in strategic planning for and evaluation of the Care Management process/unit.
  10. Assists with staff educational training and in-service programs and serves as a clinical resource for client
  11. All other duties as required by the Medical Director/Chief Operating Physician Officer/Program Lead
QUALIFICATIONS

  • Minimum Education, Licensure and Professional Certification requirement:Board Certified in Orthopaedic Spine Surgery or Neurosurgery, General Orthopaedic Surgery or Interventional Pain (PM&R), at time of hire with an active unrestricted license to practice medicine in a state or territory the United States as a doctor of medicine or doctor of osteopathic medicine.For Orthopaedic or Neurologic Surgeons must include the independent performance of standard orthopedic surgical procedures.A fellowship in spine surgery or extensive spine surgery experience is desirable.
  • Minimum Experience required (number of years necessary to perform role): Must have a minimum of five (5) years of clinical practice experience past fellowship training. Candidates must have recent active surgical practice experience in direct patient care (within the past 18 months), and have familiarity with the use of non-invasive and invasive imaging technologies in the management of patients. and have familiarity with the use of non-invasive and invasive imaging technologies in the management of patients.

Education:
University - MD




How to Apply:


 
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