Medical Director - Outpatient Medicare

📋 Description

• Review health claims, clinical documentation, and complex clinical cases.
• Determine medical necessity and authorize services, levels of care, and sites of service.
• Conduct utilization reviews across inpatient, post-acute, and outpatient settings.
• Evaluate records against guidelines, CMS policies, and internal requirements.
• Apply Medicare/Medicare Advantage rules to day-to-day decisions.
• Collaborate with care teams and regional leaders on complex cases and initiatives.

🎯 Requirements

• MD or DO degree from an accredited medical school.
• At least 5 years of direct clinical patient-care experience after residency/fellowship.
• Board Certification in an ABMS-approved specialty.
• Unrestricted medical license in at least one U.S. jurisdiction, willing to obtain others as needed.
• Strong communication, analytical, and collaborative skills.
• Experience with utilization management and post-acute care preferred.

🎁 Benefits

• Salary: $223,800–$313,100 per year (varies by location, skills, experience, certifications).
• Bonus: Eligible for performance-based incentive plan.
• Healthcare: Medical, dental, and vision coverage.
• Retirement: 401(k) plan.
• Time off: Paid PTO and holidays; parental and caregiver leave.
• Insurance: Short/long-term disability and life insurance.