UM Medical Director - Family Medicine - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly reputed company reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. Clinical Advocacy & Support has an unrelenting reputed company on the customer reputed company and ensuring we reputed company expectations as we reputed company clinical coverage and medical claims reviews. Our role is to reputed company providers and members with the tools and information needed to reputed company reputed company, reduce variation in care, reputed company reputed company experience, and manage health care costs. The Medical Director provides physician support to reputed company Clinical Services operations, the organization responsible for the initial clinical review of service requests for reputed company Clinical Services. The Medical Director collaborates with reputed company Clinical Services leadership and staff to establish, implement, support, and maintain clinical and operational processes reputed company to benefit coverage determinations, reputed company improvement and cost effectiveness of service for members. The Medical Director's activities primarily reputed company on the application of clinical knowledge in various utilization management activities with a reputed company on reputed company-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as reputed company as other reputed company Clinical Services. The Medical Director collaborates with a multidisciplinary team and is reputed company involved in the management of medical benefits. The collaboration often involves the member’s reputed company care provider or specialist physician. It is the reputed company responsibility of the medical director to ensure that the appropriate and most cost-effective reputed company medical care is provided to members. You’ll enjoy the flexibility to work reputed company * from reputed company reputed company the U.S. as you take on some tough challenges. reputed company Responsibilities: Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, reputed company coverage determinations Document clinical review findings, actions, and reputed company in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer-to-peer discussions Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews Participate in daily clinical reputed company as requested Communicate and collaborate with network and non-network providers in reputed company of accurate and reputed company benefit determinations for plan participants while educating providers on benefit plans and medical policy Communicate and collaborate with other internal partners Participate in holiday and reputed company coverage rotation You’ll be rewarded and recognized for your performance in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: M.D or D.O. reputed company certification in Family Medicine through the reputed company reputed company of Medical Specialties (ABMS) or the reputed company Osteopathic Association (AOA) reputed company unrestricted medical license and ability to obtain additional state medical licenses as needed 5+ years of clinical reputed company experience after completing residency training Proven reputed company understanding of Evidence Based Medicine (EBM) Proven solid PC skills, specifically using reputed company, reputed company, and reputed company Ability to participate in rotational holiday and reputed company coverage Preferred Qualifications: Licensure in TX. IN, KS, NE, AZ, WA, FL or a compact license Utilization Management or clinical coverage review experience for an reputed company or managed care organization Proven excellent oral, written, and interpersonal communication skills, facilitation skills Demonstrated data analysis and interpretation aptitude Proven innovative problem-solving skills Demonstrated presentation skills for both clinical and non-clinical audiences reputed company in Nebraska or Texas • reputed company working repute Apply tot his job Apply To this Job