Medical Review Institute of America
Associate Medical Director - Utilization Review
Medical Review Institute of America - Salt Lake City, Utah, United States, 84193
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Associate Medical Director - Utilization Review
role at
Medical Review Institute of America . **Position Overview:** 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, clinical reference materials, internal teaching conferences, and other references. **Key Responsibilities:**
Medical Decision Making:
Use inpatient clinical expertise, familiarity with MCG/InterQual guidelines, health plan policies, and experience in acute care, co-morbidities, and disease management to review records and make evidence-based determinations. Communication:
Conduct peer-to-peer calls with external providers to gather clinical information and discuss case determinations. Collaboration:
Support internal workflows and foster effective relationships across teams and stakeholders. Compliance and Support:
Ensure decisions and processes adhere to national guidelines, CMS regulations, URAC standards, and contractual requirements. **Ideal Candidate Profile:**
Willing and able to work a structured schedule: 40 hours/week, including weekend shifts, between 6:00am – 7:00pm Mountain Time. Full attention during scheduled hours is required. Highly skilled in inpatient co-morbidities management, with strong clinical judgment. Proficient with computers and above-average computer literacy. Demonstrates integrity, professionalism, resourcefulness, and supports team collaboration. Able to work independently after structured training, in a structured environment. Exercises independence in meeting compliance and timeliness expectations. **Minimum Qualifications:**
MD or DO with current board certification in Family Medicine or Internal Medicine. At least 5 years of recent direct patient care, including 3 years in inpatient hospital settings; ICU experience preferred. Strong computer skills and willingness to obtain additional state licenses (MRIoA will manage and cover costs). Clean background with no prior licensure issues or pending malpractice. Passed USMLE, COMLEX-USA, or equivalent exam components within three attempts. Must reside and work within the United States. **Additional Information:** This position is full-time, remote, and requires dedication during scheduled hours. MRIoA is an equal opportunity employer and a drug-free workplace. All candidates must pass a background check and drug screen. For more details, visit MRIoA Privacy Policy and Terms of Use on their website.
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Associate Medical Director - Utilization Review
role at
Medical Review Institute of America . **Position Overview:** 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, clinical reference materials, internal teaching conferences, and other references. **Key Responsibilities:**
Medical Decision Making:
Use inpatient clinical expertise, familiarity with MCG/InterQual guidelines, health plan policies, and experience in acute care, co-morbidities, and disease management to review records and make evidence-based determinations. Communication:
Conduct peer-to-peer calls with external providers to gather clinical information and discuss case determinations. Collaboration:
Support internal workflows and foster effective relationships across teams and stakeholders. Compliance and Support:
Ensure decisions and processes adhere to national guidelines, CMS regulations, URAC standards, and contractual requirements. **Ideal Candidate Profile:**
Willing and able to work a structured schedule: 40 hours/week, including weekend shifts, between 6:00am – 7:00pm Mountain Time. Full attention during scheduled hours is required. Highly skilled in inpatient co-morbidities management, with strong clinical judgment. Proficient with computers and above-average computer literacy. Demonstrates integrity, professionalism, resourcefulness, and supports team collaboration. Able to work independently after structured training, in a structured environment. Exercises independence in meeting compliance and timeliness expectations. **Minimum Qualifications:**
MD or DO with current board certification in Family Medicine or Internal Medicine. At least 5 years of recent direct patient care, including 3 years in inpatient hospital settings; ICU experience preferred. Strong computer skills and willingness to obtain additional state licenses (MRIoA will manage and cover costs). Clean background with no prior licensure issues or pending malpractice. Passed USMLE, COMLEX-USA, or equivalent exam components within three attempts. Must reside and work within the United States. **Additional Information:** This position is full-time, remote, and requires dedication during scheduled hours. MRIoA is an equal opportunity employer and a drug-free workplace. All candidates must pass a background check and drug screen. For more details, visit MRIoA Privacy Policy and Terms of Use on their website.
#J-18808-Ljbffr