Medical Director

Role Overview

• Provide timely expert medical review of medical necessity requests for clinical services (including post-acute care)
• Render a clinical opinion about the medical service under review, including post-decision reviews
• Provide timely and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome decisions
• Document all actions related to clinical review sessions and attest to review qualifications as required
• Participate in rounds as necessary when providing coverage for other Medical Directors
• Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications
• Support the review of eviCore clinical guidelines
• Support and communicate eviCore policies and procedures to the provider community
• Testify at ALJ Hearings when your cases are being appealed
• Assist with staff educational training and in-service programs and serve as a clinical resource for eviCore staff
• Serve as a Subject Matter Expert when Medical Directors and/or Senior Medical Directors are unavailable
• Participate in all required educational and quality improvement activities and maintain passing scores in all assessments
• Assist in reviewing case determinations from clients responding to a provider or member complaint
• Maintain necessary credentials and immediately inform eviCore of any adverse actions relating to medical licenses and/or board certifications

Requirements

• M.D. or D.O. degree from accredited institution
• Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable)
• Active board certification, primary care specialties (Family Medicine, Internal Medicine, Emergency Medicine) preferred
• Active unrestricted license to practice medicine in a state or territory of the United States as a utilization review doctor of medicine or doctor of osteopathic medicine
• Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management
• Must be able to type 30 WPM
• Proficient computer skills and knowledge of Microsoft Office applications

Benefits

• medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays