Medical Director at The Judge Group Inc. in Miami, Florida

Job Description:

Location: REMOTE

Salary: $115.00 USD Hourly - $117.00 USD Hourly

Description:

Job Title: Medical Director, Utilization Management Physician



Job Type: Contract



Location: Remote



Hours: 40 hours/weekly



Rate: Starting at $115/hourly (Negotiable)



Essential Job Functions:

• Assist in developing and maintaining an efficient UM program to meet the needs of health plan members, aligned with company values.


• Stay current and proficient in CMS criteria hierarchy and organizational determination processes.


• Participate in case review and medical necessity determination.


• Maintain proficiency in compliance regulations for both CMS and delegated health plans.


• Conduct post-service reviews for medical necessity and benefits determination coding.


• Assist in developing medical management, care management, and utilization management protocols.


• Perform all other related duties as assigned.


• Oversee and ensure physician compliance with the UM plan.


• Perform all duties in a professional and responsible manner.


• Respond to physicians and staff promptly, pleasantly, and professionally.


• Respect physician, patient, and organizational confidentiality.


• Provide quality assurance and education on current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures, offering counsel when criteria are not met.


• Strive to expand personal knowledge of all aspects of the UM department.


• Actively participate in physician meetings.


• Orient new physicians to ensure understanding of company policy and available resources for physician support.


• Assist in the growth and development of subordinates by sharing special knowledge and promoting continued education classes.


• Attend continuing education classes to stay abreast of medical advancements and innovative practice guidelines.

Required Qualifications:

• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.


• Board certification in Family Medicine or Internal Medicine.


• An active, unrestricted medical license (any state).


• Five or more years of post-residency clinical practice experience.


• Proficiency with Microsoft Office applications.

Preferred Qualifications:

• Two or more years of experience in utilization management activities.


• Two or more years of experience with acute admissions.


• Two years of experience working in a managed care health plan environment.


• Bilingual (English/Spanish) fluency.

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Contact: mgautreau@judge.com


This job and many more are available through The Judge Group. Find us on the web at www.judge.com Apply Now