Medical Director - Post-Acute Care Management - Care Transitions - Remote

Primary Responsibilities:

• Provide daily utilization oversight and external communication with network physicians and hospitals
• Daily UM reviews - authorizations and denial reviews
• Conduct peer to peer conversations for the clinical case reviews, as needed
• Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
• Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions services
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
• Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
• Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
• Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
• Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
• Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
• Regularly meet with Care Transitions’ leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
• Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions products and services
• Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
• Participate on the Medical Advisory Board
• Providing intermittent, scheduled weekend and evening coverage
• Perform other duties and responsibilities as required, assigned, or requested

Required Qualifications:

• MD or DO degree
• Active, unrestricted medical license in at least one U.S. state, with ability to obtain licensure in additional states if requested
• Current Board Certification in ABMS or AOA specialty
• 3+ years of patient care experience, post-residency

Preferred Qualifications:

• Licensure in multiple states
• Willing to obtain additional state licenses, with Care Transitions support
• Proven understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care
• Demonstrated competence in use of electronic health records as well as associated technology and applications
• Proven excellent organizational, analytical, verbal and written communication skills
• Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues
• Proven highest level of ethics and integrity
• Demonstrated ability to work within a team environment while completing multiple tasks simultaneously
• Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
• Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
• Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals