Full Time Utilization Review (Medical Director)

Associate Medical Director – Utilization Review Position

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DESCRIPTION

The Medical Director leverages their medical experience and judgment to determine whether requested services, levels of care, and/or sites of service should be authorized. This role operates within a framework of criteria from the patient’s healthcare plan, regulatory compliance, and utilizing diverse resources such as national clinical guidelines, CMS policies and clinical reference materials.

Medical Decision Making: Leverage in-depth inpatient clinical expertise, including familiarity with MCG/InterQual guidelines and health plan policies, along with acute care, co-morbidities, and disease management experience, to review medical records and deliver evidence-based determinations on service requests.

 Compliance and Support: Ensure all decisions and processes adhere to national guidelines, CMS regulations, URAC standards, clinical best practices, and contractual requirements.

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IDEAL CANDIDATE PROFILE

·         Willing and able to work the structured schedule: This is NOT a flexible position. You will be scheduled 40 hours per week (5, 8 hours shifts per week) including weekend shifts. Work hours are between 6:00am – 7:00pm Mountain Time Zone. Your full attention must be dedicated to the position during scheduled hours. No exceptions to the schedule will be permitted.

·         Medical skill and experience: Highly skilled in managing in-patient co-morbidities, with the ability to apply clinical judgement to determine appropriate patient outcome.

·         Computer skill: Be highly adept with computers, possess above average computer literacy.

·         Team Collaboration: Supports and collaborates with team members, other departments, colleagues, and leadership.

·         Independence and Structure: After completing structured and mentored training, performs daily tasks with minimal supervision but with ready support from team members. Enjoys working in a structured environment with consistent thinking and authorship.

·         Compliance and Timeliness: Exercises independence in meeting departmental expectations and compliance timelines.

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TO QUALIFY 

·         MD or DO degree, with current board certification in Family Medicine or Internal Medicine.

·         5 years of recent direct patient care experience, which must include at least 3 full years of in- patient hospital experience in an acute care setting, ICU experience preferred.

·         Be highly adept with computers, with strong computer literacy.

·         Be willing to obtain up to 20 additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them).

·         Clean background, without any prior licensure issues or pending malpractice (background or malpractice issues can delay the process of obtaining additional licenses).

·         Must have passed each component of the USMLE, COMLEX-USA, or equivalent predecessor exam accepted by the state medical board (such as the FLEX or NBME) in no more than three attempts for each component.

·         You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours.

·         You must reside and work within the United States.

You can apply here: www.mrioa.com or email Holly.Benson@mrioa.com.

About Medical Review Institute of America

Medical Review Institute of America (MRIoA) has been an industry leader in physician peer review for over 30 years. As an Independent Review Organization, we conduct independent/impartial reviews to ensure that services provided are in accordance with recognized standards of care and based on current scientific medical literature and guidelines. Our reviewers also review health plan coverage policies to determine if a patient's treatment is covered. MRIoA utilizes a nationwide network of board-certified physician specialists and professionals in over 133 specialties and sub-specialties of medicine. MRIoA holds dual accreditation with URAC with certificates in Health Utilization Management and as an Independent Review Organization. In addition, MRIoA is NCQA and SSAE 16 certified.