Assistant Medical Director

Assistant Medical Director

Remote (MUST be located and licensed in Ohio)

Schedule: Mon-Fri 8-5pm

Pay Rate: $125 -135 / Hour

6-month contract

Job Details:

• Provides clinical expertise to promote the delivery of high quality, cost effective, (member centric) medical care.
• Contributes to the achievement of clinical excellence; quality ratings improvement, appropriate inpatient and outpatient utilization, affordability, compliance, growth and focused improvement, and that initiatives are consistently implemented and successfully executed to achieve goals.
• Provides clinical expertise to the utilization review process and determinations.
• Provides pre-determination reviews and reviews of claims determinations, providing clinical, coding and reimbursement expertise.
• Ensures compliance with clinical goals through monitoring of care management performance.
• Ensures the appropriate and most cost-effective medical care is received.
• Recommends changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
• Assists in development and interpretation of medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.

Job Requirements:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school.
• Minimum of 5 years of established (clinical) care practice experience required.
• MUST have commercial and Medicare Advantage experience.
• Physician reviewer experience in the insurance industry preferred.
• Board Certification, in nationally recognized specialty (ABMS or AOA) is required.
• Active unrestricted license to practice medicine in OH.