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The Clinical Operations Associate Medical Director is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers.
Job Responsibility:
Ensures timely completion of clinical case reviews for their board certified specialty
Makes physician to physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested
Makes medical necessity determinations for grievance and appeals appropriate for their specialty
Ensures consistent use of medical policies when making medical necessity decisions
Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation
Requirements:
Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA)
Must possess an active unrestricted medical license to practice medicine or a health profession
Nice to have:
Board Certification by American Board of Medical Specialties in Sleep Medicine strongly preferred
3-5 years of clinical practice experience past fellowship training is desirable
What we offer:
comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical, dental, vision, short and long term disability benefits
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