Medical Director - OP Medicare

📋 Description

• Review moderately complex to complex outpatient cases and use clinical expertise and medical
• Conduct utilization management reviews in accordance with CMS requirements, Medicare and Medicare
• Analyze clinical documentation and medical records to make accurate, evidence-based coverage and
• Communicate clinical decisions and determinations clearly to internal teams and relevant
• Collaborate with external physicians to obtain additional clinical information, participate in
• Participate in care management activities supporting quality outcomes, care coordination

🎯 Requirements

• MD or DO degree with at least 5 years of direct clinical patient care experience following
• Current and ongoing board certification in an approved ABMS medical specialty.
• Current, unrestricted medical license in at least one U.S. jurisdiction, with willingness to obtain
• Clinical experience preferably including outpatient care and/or care for Medicare-type populations
• Ability to meet credentialing requirements and no current sanctions from federal or state
• Strong analytical and interpretive abilities, with sound judgment when evaluating clinical

🎁 Benefits

• Salary: $223,800–$313,100 per year, with individual compensation varying based on location, skills
• Bonus: Eligibility for a performance-based incentive plan.
• Remote work: Nationwide remote position with typical Monday–Friday business hours and some
• Time off: Paid time off, company holidays, and personal holidays.
• Family support: Paid parental and caregiver leave.
• Healthcare: Medical, dental, and vision coverage.