Associate Medical Director, Health Services UM & Virtual Support
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American Specialty Health IncorporatedHealthcare
Listing locations: USA; This WFH positionPart-TimeDirector
Salary90 - 110 USD per hour
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Job Details
- Experience
- 5 years of Clinical practice experience required.
Requirements
- Graduate of an accredited medical college in the US.
- Board certified.
- Hold a current, unrestricted medical or osteopathic license in the United States.
- Be able and willing to obtain and maintain state medical licenses in other states as requested.
- Have 5 years of clinical practice experience.
- Have experience in musculoskeletal medicine and/or knowledge of Physical Therapy.
- Have experience in Utilization Management (UM) and Medical Necessity Review.
- Have experience in provider discussions related to UM decisions.
- Have experience in Clinical Quality Assurance or Quality Management.
- Maintain active clinical credentials in good standing with the State Board.
- Have excellent computer skills.
Responsibilities
- Make medical management utilization management decisions as required by state regulation, delegation, appeals, or client requirements.
- Make medical decisions in support of delegated ASH Appeals Processes.
- Review medical necessity for Physical Therapy, Occupational Therapy, Speech Therapy, Athletic Training, chiropractic, and acupuncture programs.
- Support utilization management activities, including file reviews as needed.
- Provide virtual telehealth medical support as requested.
- Support CQE team members with training, auditing, and other projects.
- Support other medical directors with MNR backup and assist CHSO and Health Services with special projects.
- Attend clinical committee meetings supporting clinical quality management processes.
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