Part-Time Weekend Medical Director (Remote)

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Requirements:

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required.
• 5 years of experience in Clinical, Direct Patient care in settings like hospital, outpatient or private practice.
• Preferred: 1 year in Medical Management with strong knowledge of the managed care industry.
• Awarded Board Certification in specialty recognized by appropriate boards.
• Active state medical licensure required.

Responsibilities:

• Conduct electronic review of escalated cases to determine medical necessity and appropriateness.
• Complete initial determination of cases, review appeals and grievances.
• Compose clear rationales for member and provider notifications consistent with compliance standards.
• Participate as a member of the CMDM multidisciplinary team and advise on high-risk cases.
• Manage or participate in projects requiring physician expertise.