Medical Director - 257394
Medical Director - Utilization Management
Responsibilities
Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department
Required Qualifications
Medical Degree (MD or DO) from an accredited program. Current Board Certification in a recognized clinical specialty. Active, unrestricted medical license in North Carolina Compensation and Benefits $210,000 - $269,000+/yr Fully remote work environment, on-site training in Raleigh, NC. Comprehensive equipment provided by the client. Stable 40-hour work week with a flexible schedule (typically 8:30 AM – 5:00 PM EST).