Medical Director Clinical Advocacy and Support - DME, Musculoskeletal - Telecommute

Minneapolis, MN

Non clinical

Primary Responsibilities:

  • Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
  • Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements
  • Engage with requesting providers as needed in peer-to-peer discussions
  • Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
  • Participate in daily clinical rounds as requested
  • Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
  • Communicate and collaborate with other internal partners
  • Call coverage rotation

Required Qualifications:

  • M.D or D.O.
  • Board certification approved by the American Board of Medical Specialties (ABMS)
  • Active unrestricted license to practice medicine
  • 5+ years of clinical practice experience after completing residency training
  • Sound understanding of Evidence Based Medicine (EBM)
  • Proven PC skills, specifically using MS Word, Outlook, and Excel

Preferred Qualifications:

  • Board Certification in Family Medicine, Internal Medicine, or Physical Medicine & Rehabilitation
  • Previous experience in utilization and clinical coverage review
  • Data analysis and interpretation aptitude
  • Excellent oral and written communication skills
  • Interpersonal communication and facilitation skills
  • Innovative problem-solving skills
  • Excellent presentation skills for both clinical and non-clinical audiences

Posted November 30, 2021