Pacer Group
Direct message the job poster from Pacer Group
Director - Client Services, Recruitments & Operations
Shift - 8.00am 5.00pm in what time zone they reside within (EST, CST, PST) Location - Remote Note : Flexible hours are something the team is discussing to ensure there is coverage for as needed weekends and holidays There could be an opportunity to be on weekends only, etc. Possibility for Saturday and Sunday Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Responsibilities Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees. May be required to work weekends and holidays in support of business operations, as needed. Business groups and Key Projects Corporate 12-15 cases per day of UM decisions (inpatient, outpatient, Prior Auth, etc.) Reviewing cases to understand if medical necessity is met They will follow established guidelines and determine if the medical necessity is met or not Completed through EMR system (Clients system) Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Backgrounds that would be helpful UM experience (minimum of 1 year experience) Requirements Required: Medical Doctor or Doctor of Osteopathy. Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Associations Department of Certifying Board Services. Must haves: For Behavioral Health only - Board certification by the American Board of Psychiatry and Neurology. Current state medical license without restrictions. UM experience (minimum of 1 year experience) Must have ability to obtain licensure within multiple states Nice to haves: UM experience Not meeting the board certification Performance indicators: Production capacity around the 12-15 cases per day Quality of the review A strong candidate would meet the following: Clinical Expertise : Board-certified physician with active practice experience. UM Proficiency:
Proven ability to handle high-volume case reviews efficiently and accurately. Behavioral Health Experience:
Essential if applying for roles requiring psychiatry certification. Tech Savvy:
Comfortable using EMR systems and collaborating virtually. Adaptability:
Can work independently in a remote setting while engaging with a dynamic team. Regulatory Knowledge:
Familiarity with accreditation standards and state-specific requirements. Seniority level
Seniority level
Associate Employment type
Employment type
Contract Job function
Job function
Health Care Provider Industries
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Shift - 8.00am 5.00pm in what time zone they reside within (EST, CST, PST) Location - Remote Note : Flexible hours are something the team is discussing to ensure there is coverage for as needed weekends and holidays There could be an opportunity to be on weekends only, etc. Possibility for Saturday and Sunday Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Responsibilities Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees. May be required to work weekends and holidays in support of business operations, as needed. Business groups and Key Projects Corporate 12-15 cases per day of UM decisions (inpatient, outpatient, Prior Auth, etc.) Reviewing cases to understand if medical necessity is met They will follow established guidelines and determine if the medical necessity is met or not Completed through EMR system (Clients system) Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Backgrounds that would be helpful UM experience (minimum of 1 year experience) Requirements Required: Medical Doctor or Doctor of Osteopathy. Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Associations Department of Certifying Board Services. Must haves: For Behavioral Health only - Board certification by the American Board of Psychiatry and Neurology. Current state medical license without restrictions. UM experience (minimum of 1 year experience) Must have ability to obtain licensure within multiple states Nice to haves: UM experience Not meeting the board certification Performance indicators: Production capacity around the 12-15 cases per day Quality of the review A strong candidate would meet the following: Clinical Expertise : Board-certified physician with active practice experience. UM Proficiency:
Proven ability to handle high-volume case reviews efficiently and accurately. Behavioral Health Experience:
Essential if applying for roles requiring psychiatry certification. Tech Savvy:
Comfortable using EMR systems and collaborating virtually. Adaptability:
Can work independently in a remote setting while engaging with a dynamic team. Regulatory Knowledge:
Familiarity with accreditation standards and state-specific requirements. Seniority level
Seniority level
Associate Employment type
Employment type
Contract Job function
Job function
Health Care Provider Industries
Hospitals and Health Care Referrals increase your chances of interviewing at Pacer Group by 2x Get notified about new Medical Director jobs in
United States . United States $325,000.00-$350,000.00 6 days ago New York, NY $200,000.00-$300,000.00 1 month ago Los Angeles, CA $275,000.00-$300,000.00 4 weeks ago United States $325,000.00-$350,000.00 5 days ago Head Medical Excellence and New Products
United States $200,000.00-$300,000.00 4 days ago United States $350,000.00-$425,000.00 3 weeks ago Los Angeles, CA $160,000.00-$175,000.00 1 month ago United States $170,000.00-$185,000.00 3 weeks ago United States $290,000.00-$315,000.00 5 days ago Director Clinical Operations (medical device)
United States $190,000.00-$240,000.00 2 weeks ago United States $200,000.00-$240,000.00 2 days ago United States $180,000.00-$210,000.00 3 days ago Boston, MA $250,000.00-$315,000.00 3 weeks ago United States $130,000.00-$160,000.00 4 days ago Director of Integrated Behavioral Health
Medical Director- Ambulatory Virtual Care
United States $222,000.00-$377,400.00 1 week ago United States $228,000.00-$244,000.00 5 days ago Executive Director, Medical and Payment Policy
United States $181,500.00-$272,300.00 3 days ago United States $130,000.00-$160,000.00 4 days ago Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr