CareCentrix logo
CareCentrix

Empowering Health at Home

Medical Director

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 1,001-5,000Since 1996H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

82 days ago

Salary

$250K - $270K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Medical Director

CareCentrix

• Provides clinical oversight and utilization management for Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep Medicine, and related services. • Conducts medical necessity reviews using industry-standard clinical criteria and evidence-based guidelines to support coverage determinations and quality care outcomes. • Conducts efficient medical necessity reviews and peer to peer consultations in adherence with regulatory and compliance turnaround times on cases that may not meet clinical criteria. • Issues adverse determinations as needed. • Provides guidance to licensed and non-licensed associates on clinical issues and case reviews related to authorization requests and clinical guidelines criteria. • Completes peer to peer discussions when medical necessity criteria are not met. • Participates in CareCentrix Care Coordination, Utilization Management, Quality Improvement and clinical education activities, as requested. • Utilizes clinical integrity in all determinations and interactions with internal and external partners. • Collaborates with Health Plan clinical leadership as requested. • Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients. • Participates and supports different committees and clinical rounds as necessary or assigned.

Job Requirements

  • MD or DO with an active and unencumbered medical license.
  • Must have active ABIM or ABMS specialty board certification(s).
  • Minimum of 5 years’ experience in an area of relevant clinical practice.
  • At least 3 years’ experience with supporting utilization management reviews, managed care programs or care delivery networks.
  • Expertise in Home Health, DME and sleep fields, including current knowledge on best practices.
  • General knowledge of regulatory and accreditation standards for payers and health care providers.
  • Expertise in Health Plan or Payer Utilization Management (UM)
  • Strong team player with the ability to collaborate effectively across multidisciplinary teams and stakeholders.
  • This position requires excellent written and verbal communication skills.
  • Conveys a strong professional image, exhibits interest quality improvement, and projects a positive attitude toward all assigned work.
  • Adheres to and participates in Company's mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.

Benefits

  • Paid Flex Time Off (FTO)
  • 401K Savings Plan
  • Paid Parental Leave
  • Medical
  • Dental
  • Vision
  • HSA employer contributions
  • Dependent Care FSA employer contribution
  • Paid Time Off
  • Personal/Sick Time
  • Award winning culture

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Sanofi logo

Associate Director Commercial Excellence, US Vaccines

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Full TimeRemoteTeam 11-50H1B No Sponsor

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Blackhawk Network logo

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Medical Director82 days ago

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$215K - $280K / year
Job Closed