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Medical Director - Remote

Date: Oct 4, 2021

Location: Any city, NV, US, 99999

Company: Gainwell Technologies LLC

Job Description

Position Overview:

Provide medical expertise to staff, management, and customer within a health care account. Act as liaison to client and providers by resolving problems and clarifying medical and healthcare issues. Recommend and promote beneficial changes to customer programs to promote access to quality care and control of benefit packages. Assist in adjudication of medically complicated claims. The physician is to help with cost containment and utilization review measures to make payment for only those treatments and services that are medically necessary, appropriate, and cost effective. The physician will be trained on applicable program criteria and will apply these criteria in utilization management decision-making.

Position Prerequisites:

  • Medical degree in Medicine
  • Unrestricted license to practice medicine as an MD
  • Qualified by education and experience to provide clinical oversight
  • Post graduate experience in direct patient care
  • Board certification

Essential Functions:

  • Provide oversight and function as subject matter expert
  • Participate on Quality Improvement Committee as Medical Director
  • Ability to apply clinical criteria to make determinations related to medical necessity for requested services, medications, and procedures independent of cost-containment efforts
  • Strong oral/written communication skills
  • Ability to read, understand, and interpret complex regulatory and procedural documents
  • PC skills
  • Time management and organizational skills
  • Ability to work independently
  • Strong analytical skills
  • Ability to successfully interact with other departments
  • Services provided while in United States

Work Environment

  • Remote US