Medical Director Associate

Mindlance

OFF PREMISES, CO

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JOB DETAILS

SALARY

$120–$159 Per Hour

SKILLS

Analysis Skills, Clinical Medicine, Clinical Practices/Protocols, Clinical Validation, Communication Skills, Consulting, Diversity, Federal Laws and Regulations, Health Plan, Healthcare, Healthcare Quality, Interpersonal Skills, Leadership, Medicine, On Call, Problem Solving Skills, Project Estimates, Project/Program Management, Provider Credentialing, State Laws and Regulations, Technology Analysis, Time Management, United States Military, Utilization Management, Utilization Review Accreditation Commission (URAC), Writing Skills

LOCATION

OFF PREMISES, CO

POSTED

1 day ago

Please Note: If this is not a straight backfill, please consult with your HR Business Partner prior to posting/using this job. Responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review. Primary duties may include, but are not limited to: May provide clinical guidance for programs. Supports clinicians to ensure timely and consistent responses to members and providers. Conducts peer-to-peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, and patients office visits with providers and external physicians. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations. May participate in a physician on-call rotation for a 24x7 unit. May assist in the practitioner appeal reviews, appropriateness criteria reviews, medical technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing. Under direction, may be responsible for the administration of medical services for company health plans including medical policies. Serves as a resource and consultant to other areas of the company. May interpret existing medical policy. May be required to represent the company to external entities and/or serve on internal and/or external committees. Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Must possess an active unrestricted medical license to practice medicine or a health profession. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. {Note: The following are level distinctions not required for posting. This level typically is more of a supportive position with oversight from a Medical Director. May be responsible for a portion of a clinical program and/or performing clinical reviews. Is more involved in supporting one or more Medical Directors, as well as the programs to which the Medical Director is assigned. May manage pieces of programs, but would not have the full scope of program management expected of the Medical Director. Receives guidance and oversight from a Medical Director who is an individual contributor in addition to direction received from immediate manager.} For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

About the Company

Mindlance

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