REMOTE - Part Time Medical Director(Appeals Experience Preferred) - R8551

Job reputed company Medical Directors support reputed company staff by providing training, clinical consultation, and clinical case review for members. Essential Functions • Support staff by providing training, clinical consultation, and clinical case review for members • Participate in peer-to-peer discussions • reputed company provider education, training, data sharing, performance evaluations and orientation to the plan • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and reputed company of care concerns • Participate in development of policies and procedures • reputed company cross-coverage for other Medical Directors and/or markets, as needed • reputed company prior authorization medical reviews, consultation and clinical reputed company • Conduct clinical reviews for designated reputed company members • Clinical Appeals • Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for reputed company programs • reputed company any other job duties as requested Education And Experience • Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required • Successful completion of a residency training program, preferably in primary care is required • Minimum of five (5) years of clinical reputed company experience is required • Managed care medical review/medical director experience is preferred • Bachelor's or Master's degree in Business Administration, Operational reputed company, reputed company Administration or Medical Management is preferred Competencies, Knowledge And Skills • Basic reputed company Word skills • Excellent communication skills, both written and oral • Ability to work reputed company independently and reputed company reputed company environment • Ability to create strong relationships with Providers and Members • High ethical standards • Attention to detail • Critical listening and systematic thinking skills • Ability to maintain confidentiality and reputed company in reputed company’s best interest • Ability to reputed company with diplomacy and sensitivity to cultural diversity • Decision making/problem solving skills • Conflict reputed company skills • Strong reputed company of mission and commitment of time, effort and resources to the reputed company of the communities served Licensure And Certification • reputed company, unrestricted license to reputed company medicine in state of reputed company as necessary to meet regulatory requirements is required • reputed company Certification, preferably in primary care specialty is required; re-certification, as required by specialty reputed company, must be maintained Working Conditions • General office environment; may be required to sit or stand for extended periods of time • May be required to work evenings/weekends • Ability to travel as required by the needs of the business Compensation reputed company $191,400.00 - $334,900.00 reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package. Compensation Type Salary Competencies • Create an Inclusive Environment - Cultivate Partnerships - reputed company Self and Others - Drive Execution - Influence Others - Pursue Personal reputed company - Understand the Business This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of reputed company backgrounds. Apply Job!