Medical Director Utilization Management
New
C
Cohere HealthHealth Tech
Location: United StatesFull-TimeManager
Salary240,000 - 250,000 USD per year
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Job Details
- Experience
- 5+ years of clinical practice beyond residency/fellowship in Internal Medicine
Requirements
- Completed US-based residency program and fellowship in Internal Medicine.
- Board certification as an MD or DO.
- Current unrestricted state license to practice medicine.
- 5+ years of clinical practice beyond residency/fellowship in Internal Medicine.
- Understanding of managed care regulatory structure and processes.
- Ability to work autonomously with little supervision.
- Comfortable with technology and willingness to learn new software tools.
- 1+ years of managed care utilization review experience desirable.
- Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable.
Responsibilities
- Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature.
- Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes.
- Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters.
- Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines.
- Clearly and accurately document all communication and decision-making in Cohere workflow tools.
- Use correct templates for documenting medical necessity decisions during case review.
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions.
- Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers.
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