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Capital Rx

Affordable Pharmacy Benefits, Powered by Modern Infrastructure.

Medical Director – Texas Licensed

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 501-1,000Since 2017H1B No SponsorCompany SiteLinkedIn

Location

Texas

Posted

4 days ago

Salary

$84K - $105K / year

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Medical Director – Texas Licensed

Capital Rx

• Medical Director will complete assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients; governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate • Makes clinical determinations in accordance with medical necessity and criteria • Performs scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribers • Follow all internal procedures, job aids, and HIPPA guidelines to protect patient privacy and data security • Support the Department’s responsibilities to provide peer-to-peer phone call support to physicians/prescribers who call the company with specific and general questions about our clinical programs, communications and utilization review decisions • Communicates effectively and confidently with members to promote positive health outcomes • Actively participates in the development of utilization management (PA) criteria and clinical policy revisions/reviews • Ability to work in a fast-paced environment with shifting priorities • Weekend on-call responsibilities (shared rotating call) • Attention to detail and commitment to delivering high-quality work

Job Requirements

  • Must be a graduate of an accredited Medical School and Residency Program
  • Active Texas medical license, required
  • No history of disciplinary actions on Medical License
  • Minimum 5 years history of clinical practice with direct patient care
  • Specialty-Internal Medicine
  • Board certified by appropriate Medical Board (DO, MD)
  • Be able to satisfy rotating weekend call schedule with another Medical Director
  • Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia
  • Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employment
  • Demonstrated experience in clinical outcomes, working knowledge of medical statistics, regulatory agencies, and analytic programs
  • Ability to work with virtual teams of pharmacists
  • Time management skills to meet organizational goals
  • Knowledge of PBM environment, quality improvement and UM practices in a managed care environment
  • Knowledge of and appreciation for requirements of regulatory and accreditation agencies
  • Able to manage multiple priorities and deadlines
  • Excellent verbal, written, interpersonal and presentation skills
  • Strong knowledge of clinical medicine, health care delivery and the ability to acquire new scientific and medical knowledge
  • Proficiency with Microsoft Office applications. (e.g., MS Word, Excel, and PowerPoint minimum)

Benefits

  • Health insurance
  • 401(k) matching
  • Flexible work hours
  • Paid time off
  • Professional development opportunities

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