Medical Review Institute of America, LLC

Quality, Innovation, and Experience: Setting Us Apart

Utilization Review Medical Director

Medical DirectorMedical DirectorFull TimeRemoteTeam 501-1,000Since 1983H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

157 days ago

Salary

Not specified

Postgraduate Degree5 yrs expEnglish

Job Description

• Conduct coverage reviews using critical thinking and clinical expertise, based on individual patient/member benefits and national or proprietary coverage review policies. • Interpret benefit language and policies to guide clinical coverage determinations. • Document clinical review findings and outcomes in compliance with organizational, regulatory, and accreditation standards. • Engage in peer-to-peer consultations with prescribing providers when appropriate. • Collaborate and communicate effectively with fellow Medical Directors.

Job Requirements

Hold active state licensure as a Medical Doctor (MD/DO), any state.
Hold current board certification in either Family Medicine or Internal Medicine (no other specialty board certification is currently needed).
Possess a minimum of 5 years of direct patient care experience post training, with the most recent experience no less than 6 months ago (recent clinical care is essential).
Have recently (within the past 2 years) work in an inpatient/hospital setting.
Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
Have a clean background, without prior licensure issues, pending/prior malpractice cases or legal issues.
Possess excellent verbal and written communication skills.
Excellent interpretation skills, divergent/creative thinking skills.
Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.