Medical Director - Utilization Review

Louisville, KY

full-time
Non clinical

The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Your Skill Set

  • MD or DO degree
  • 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
  • Current and ongoing Board Certification  an approved ABMS Medical Specialty
  • A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required.
  • No current sanction from Federal or State Governmental organizations, and able to pass  credentialing requirements.
  • Excellent verbal and written communication skills .
  • Evidence of analytic and interpretation skills,  with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.
  • Residence in North Central Region ( IL, MN, ND, SD, or WI).

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Posted September 22, 2021