The Judge Group
22 hours ago Be among the first 25 applicants
This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $115.00/hr - $120.00/hr
Direct message the job poster from The Judge Group
Physician Recruiter, Executive Search Consultant, River Guide. REMOTE PHYSICIAN REVIEWER
REMOTE MEDICAL DIRECTOR
The Medical Director’s work includes reviewing all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Client processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Client's value throughout all activities.
Responsibilities
Provide medical interpretation and determine if services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Client's policies, clinical standards, and (in some cases) contracts.
Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services.
Maintain accountability for productivity, quality, and compliance metrics.
Communicate determinations clearly both verbally and in writing.
Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.
Exercise independence in meeting departmental expectations and meets compliance timelines.
Required Qualifications
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 in an approved ABMS Medical Specialty.
A current and unrestricted license in at least one jurisdiction and willingness 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 working in a team environment.
Preferred Qualifications
Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
Experience with national guidelines such as MCG® or InterQual.
Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists.
The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
Ability to thrive in a dynamic fast-paced, team-oriented environment.
Commitment to a culture of innovation, including being facile with using technology to improve workflows.
Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution.
Passionate about contributing to an organization’s focus on consistency in outcomes, consumer experiences and a highly engaged team culture.
Interview Process
All interviews will be virtual over Zoom.
1 interview with the Lead Medical Director then decision will be made.
By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.
Seniority level
Director
Employment type
Contract
Job function
Health Care Provider
Industries
Business Consulting and Services
Referrals increase your chances of interviewing at The Judge Group by 2x
Get notified about new Medical Director jobs in
Louisville, KY .
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr
This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $115.00/hr - $120.00/hr
Direct message the job poster from The Judge Group
Physician Recruiter, Executive Search Consultant, River Guide. REMOTE PHYSICIAN REVIEWER
REMOTE MEDICAL DIRECTOR
The Medical Director’s work includes reviewing all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Client processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Client's value throughout all activities.
Responsibilities
Provide medical interpretation and determine if services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Client's policies, clinical standards, and (in some cases) contracts.
Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services.
Maintain accountability for productivity, quality, and compliance metrics.
Communicate determinations clearly both verbally and in writing.
Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices.
Exercise independence in meeting departmental expectations and meets compliance timelines.
Required Qualifications
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 in an approved ABMS Medical Specialty.
A current and unrestricted license in at least one jurisdiction and willingness 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 working in a team environment.
Preferred Qualifications
Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
Experience with national guidelines such as MCG® or InterQual.
Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists.
The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
Ability to thrive in a dynamic fast-paced, team-oriented environment.
Commitment to a culture of innovation, including being facile with using technology to improve workflows.
Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution.
Passionate about contributing to an organization’s focus on consistency in outcomes, consumer experiences and a highly engaged team culture.
Interview Process
All interviews will be virtual over Zoom.
1 interview with the Lead Medical Director then decision will be made.
By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.
Seniority level
Director
Employment type
Contract
Job function
Health Care Provider
Industries
Business Consulting and Services
Referrals increase your chances of interviewing at The Judge Group by 2x
Get notified about new Medical Director jobs in
Louisville, KY .
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr