Award-winning recruitment consultancy; delivering talent across Tech, Digital, Life-Sciences, Energy & Construction
Associate Medical Director, Utilization Management
Location
Arizona + 3 moreAll locations: Arizona | Florida | New York | North Carolina
Posted
17 days ago
Salary
$240.1K - $315.2K / year
Seniority
Lead
Job Description
Associate Medical Director, Utilization Management
Oscar
• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. • Influence departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards. • Report into the Senior Medical Director. • Provide timely medical reviews that meet Oscar's stringent quality parameters. • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen. • Clearly and accurately document all communication and decision-making in Oscar workflow tools. • Use correct templates for documenting decisions during case review. • Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions. • Manage direct reports and oversee their performance. • Provide oversight to ensure the team meets turn-around times for clinical reviews. • Collaborate with other departments on Utilization Management Operations. • Lead key projects and drive initiatives to successful completion.
Job Requirements
- Board certification as an MD or DO with a current unrestricted license to practice medicine is required.
- 3+ years of clinical practice
- 2+ years of utilization review experience in a managed care plan (health care industry)
Benefits
- Performance bonus
- 401K with immediate vesting
- 18 PTO days per year
- Additional bank of sick time
- Floating holidays
- CME days
Related Guides
Related Categories
Related Job Pages
More Medical Director Jobs
Radiologist Utilization Review
Medical Review Institute of America, LLCQuality, Innovation, and Experience: Setting Us Apart
Role Description We are currently seeking Board-Certified physicians in RADIOLOGY to conduct independent Utilization Reviews. This is a flexible remote opportunity requiring just 1–2 hours per week—with no minimum commitment. - Work remotely from anywhere in the US (Per HIPAA Regulations patient records cannot leave the US). - Covered under MRIoA's Errors and Omissions policy. - Independent Contractor (1099) opportunity. - Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information. Qualifications - Must have a Medical Degree MD or DO. - Must have a current state medical license in DC or Maryland. - Current Board Certification in Radiology. - Must have 5 years of clinical experience (residency to be included). - Daytime availability is required for peer-to-peer conversations. Requirements - Require a DC or Maryland State Medical License. Benefits - Flexible remote work opportunity. - No minimum commitment required. Company Description Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally recognized Independent Review Organization (IRO) specializing in technology-driven utilization management and clinical medical review solutions. We’re a leader in Peer and Utilization Reviews, known for excellence and continuous improvement.
Weekend Associate Medical Director – 0.3 FTE
Network Health WIOur mission is to create healthy and strong Wisconsin communities.
• Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and out-of-plan providers • Participate in oversight and clinical decision making of the UM program • Contribute to development of quality care guidelines, internal peer review procedures and evaluation of medical care evaluation studies • Provide medical consultation for medical/legal issues, member grievance procedures, and development of new benefit packages • Promote positive relationship between NHP and medical community • Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations • Participate in ongoing recruitment of plan physicians • Assist in development of appropriate medical guidelines and parameters for claims review
Medical Interpreter - Arabic
Mayo ClinicHeadquartered in Rochester, Minnesota, Mayo Clinic is a nonprofit medical institution ranked first in more specialties than all other hospitals in America. The company employs arou
Title: Medical Interpreter - Arabic - Supplemental Location: Rochester, MN, United States Job ID 376897 - Rochester, Minnesota - - Part Time - - International - - Remote: No Job Description: Why Mayo Clinic Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans - to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic. Responsibilities Carry out the duties of the medical interpreter with focus on lesser acute appointments; may help with higher acuity appointments depending on business need. Receives training and guidance form Medical interpreter II and Medical Interpreter III and Quality Assurance team. Supports and helps Clinical teams in their duties and responsibilities to increase successful outcomes and patient satisfaction with the hospital. Monitor self-performance with regards to interpreting skills. Help provide information on role and limitations of role to both patients and providers to contribute to a successful encounter. Utilizes terminology glossary created by Medical Interpreter III and Quality Assurance team. Actively completes training and education developed by Medical Interpreter III and Quality Assurance team. Document encounters within the Language Services dispatching system. Utilize on-line computer systems such as Outlook Express, some knowledge of Microsoft Suite is preferred, and usage of Epic as required. May be asked to help with translations or reviews on ad hoc manner. May be asked to help with on-call interpreting needs based on business need. Job may be physically demanding. This vacancy is not eligible for sponsorship, and we will not sponsor or transfer visas for this position. Qualifications - High School degree required. Additional Qualifications: - High level of customer service and a positive approach. - Familiar with diversity of various cultural and socio-economic backgrounds. - Good interpersonal, organizational, and time-management skills. - Knowledge of computer systems. - Good analytical skills. - Associates or Bachelor degree preferred. - 1-2 years of experience as an interpreter and strong medical vocabulary (including vocabulary of medical specialties, to interpret for our medical specialties clinics) is preferred. License/Certifications: - Certification through the Certification Commission for Healthcare Interpreters (CCHI) or The National Board of Certification for Medical Interpreters (NBCMI) is preferred. - The CCHI exam includes an Associate Healthcare Interpreter (AHI) status or the Certified Healthcare Interpreter (CHI) status. - Certification through the NBCMI includes the Certified Medical Interpreter (CMI) status, Qualified Medical Interpreter (QMI) status, or Screened Medical Interpreter (SMI) status. Exemption Status Nonexempt Compensation Detail Experience and tenure may be considered along with internal equity when job offers are extended.; $25.87 - $38.05 / hour Benefits Eligible No Schedule Part Time Hours/Pay Period Supplemental/as needed Schedule Details As a Supplemental interpreter there is no scheduled shift or set hours and will be requested by our ISC based on patient and staffing volumes. Supplemental interpreters would be expected to work full-time (Monday-Friday, 8am-5pm) during their roughly eight-week training period. Weekend Schedule As Needed International Assignment No Site Description Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Equal Opportunity All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Recruiter Casie Johnson
Medical Monitor
PSI CROPSI CRO is a leading provider of contract research services for clinical and pharmaceutical organizations around the world. Since 1995, the global company has aimed to become the g
Title: Medical Monitor (Canada Board-Certified Gastroenterologist) Location: Remote, Canada Job Description: - Employees can work remotely - Full-time - Compensation: CAD 170,000 - CAD 185,000 - yearly Company Description PSI is a leading Contract Research Organization with more than 30 years in the industry, offering a perfect balance between stability and innovation to both clients and employees. We focus on delivering quality and on-time services across a variety of therapeutic indications. Job Description PSI Medical Monitors provide medical input to global clinical studies and advise the teams and business partners, while always focusing on patients' safety and well-being. Home-Based in Canada Responsibilities: - Acts as the primary point of contact for all parties on all trial-specific medical and safety-related questions - Provides input for responses to regulatory authorities and Institutional Review Boards (IRBs)/Independent Ethics Committees (IECs) on trial-specific medical and safety-related questions - Monitors trial participant safety - Participates in trial participant recruitment boost and retention activities - Presents on medical matters at kick-off and investigator meetings - Trains trial team in the therapeutic area and medical aspects of the protocol - Develops and reviews trial-specific documents within the scope of medical monitoring - Manages ongoing trial risks related to medical monitoring - Performs ongoing medical review of the operational clinical trial database; provides support to Medical Reviewer(s) assigned to the trial - Reviews protocol deviations - Reviews RAE reports, writes and/or reviews SAE narratives, supports Pharmacovigilance team with outstanding safety queries, interacts with sponsor on site safety issues - Reviews IND/SUSAR Safety Reports, updates/amendments to essential trial records, and annual IND reports with sponsor data (per sponsor request) - Participates in management of trial-related committees (e.g., independent data monitoring committee (IDMC)/adjudication committees) as described in the corresponding trial-specific charter(s) - Supports Pharmacovigilance, Medical Data Review and Data Management with reconciliation of safety and operational clinical trial databases - Reviews clinical study reports (CSRs), including safety narratives and tables, figures, and listings (TFLs) - Provides medical expertise on an as-needed basis in trials where medical monitoring is not a contract deliverable - Prepares for and participates in trial audits, follows up on audit findings - Participates in feasibility assessment of potential and ongoing trials in the country/region - Participates in bid defense meetings and other interactions with clients - Acts as a medical expert and provides therapeutic expertise to other PSI departments Qualifications - Medical Doctor degree required - Canada Board Certification in Gastroenterology required - Experience as a practicing Gastroenterology (minimum of 10 years) - Clinical Research experience preferred - Proficiency with MS Office applications - Communication, presentation and analytical skills - Problem-solving, team and detail-oriented Additional Information As part of PSI's Medical Monitoring team, you will join our international group of medical professionals, build a career on the frontline of medical science and use your knowledge and expertise to help bring new medications to patients that need them.




