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Personify Health logo
Personify Health

Because health is personal

Medical Director

Medical DirectorMedical DirectorPart TimeRemoteLeadTeam 1,001-5,000Since 2023H1B No SponsorCompany SiteLinkedIn

Location

California

Posted

16 days ago

Salary

$91 - $114 / hour

Seniority

Lead

Professional Certificate

Job Description

Medical Director

Personify Health

Role Description The Medical Director relies on their medical background to review claims for medical necessity for prior authorization, continued stay review, and post service. The Medical Director can read, interpret, and apply medical policy, guidelines, and research to utilization review. The Medical Director has authority for issuing adverse determinations while performing medical necessity evaluation. - Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, requiring conflict resolution skills. - Includes an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment. - Keep the team informed of clinical updates through educational opportunities by developing educational materials for staff. - Work with the VP of Care management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives. - Excellent verbal and written communication skills. - Evidence of analytic and interpretation skills, with prior experience in quality management, utilization management, case management, discharge planning, and/or home health or post-acute services. - Knowledge of the managed care industry as it relates to commercial business. - Oversee negotiation and implementation of cost management strategies to affect quality outcomes. - Exercises independence in meeting departmental expectations and compliance timelines. - Ability to meet productivity, quality, and turnaround times daily. - Ability to pass external audits to include URAC and NCQA. - Maintain HIPAA compliance per company’s policy and procedures. - Maintain confidentiality and minimum requirement rules. - Complete all required yearly training per company’s expected period. Qualifications - MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship, preferably including some experience in an inpatient environment. - Current and ongoing Board Certification in an approved ABMS Medical Specialty. - A current and unrestricted license in the state of California and willing to obtain additional license(s), if needed. (Optional) - No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. - Minimum 5 years of Utilization Review or Hospital experience required. - Minimum 3 years of compliance-related experience preferred. - Managed Care experience preferred in utilization review and case management. Requirements - Ability to perform essential job functions safely and successfully with or without reasonable accommodation. - Ability to maintain regular, punctual attendance. - Ability to sit for 6-8 hours. - Constant use of computer keyboard and mouse; repetitive use of both hands. - Occasional to frequent twisting of neck; occasional bending of neck and at waist. Benefits - Part-time schedule designed around your availability and life priorities. - Access to learning and development opportunities alongside full-time colleagues. - Mentorship and skill-building that translates to career advancement. - Competitive hourly compensation that values your expertise. - Technology and equipment support to set you up for success.

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