Medical Director (PMR, Orthopedics, or Neurology)
New
V
Virtix Health LLCHealthcare, Utilization Management
Remote from any U.S. state.ContractManager
Salary125 USD per hour
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Job Details
- Experience
- Must be Board Certified for 3+ years
- Required Skills
- Data AnalysisEHR
Requirements
- Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
- Board certification for at least 3 years in a specialty aligning with PMR, neurology, pulmonology, urology, or orthopedics.
- Must hold an active, valid, and unrestricted medical license in at least one U.S. state or the District of Columbia.
- Must have or be willing to acquire a Washington state license.
- Must not be excluded from participating in Medicare, Medicaid, or the Children’s Health Insurance Program.
- Utilization management experience preferred.
- Familiarity with electronic health records (EHR) and documentation/coding practices (ICD-10, CPT).
- Knowledge of CMS regulations and Medicare requirements.
- Strong attention to detail and ability to work in a fast-paced, deadline-driven environment.
- Must be able to work 40 hours per week.
- Willingness to work some weekend shifts.
Responsibilities
- Conduct regular reviews to monitor the appropriateness of care provided to beneficiaries.
- Recommend necessary interventions or adjustments to align with CMS National and Local Coverage Determinations (NCD/LCD).
- Assist in the training and development of clinical teams on CMS guidelines, documentation, and compliance.
- Provide recommendations for improvements in clinical practices based on record reviews and data analysis.
- Participate in the development and implementation of quality improvement initiatives.
- Maintain accurate records of clinical reviews, audits, and quality improvement efforts.
- Perform prior authorizations for high-risk procedures for elderly patients.
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