Growth Opportunity – Associate Medical Director (Remote)

Description

To address growth, our award-winning company has new full-time, fully remote opportunities for a Utilization Review Assoicate Medical Director. 

WHO WE ARE

Founded in 1983, Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement. At MRIoA we believe our employees are the key to our success. Here you are more than just a cog in the machine – you are a valued member of our Team.

POSITION SUMMARY

Due to the continuing growth of our organization, Medical Review Institute of America (MRIoA) is currently offering a full-time, remote (work from home) position for a Medical Director to do Utilization Reviews.

As a market leader in utilization management and clinical review solutions for over 40 years, MRIoA relies on the clinical judgment of our Medical Directors to evaluate and adjudicate clinical service requests/treatment. Medical Directors use their medical knowledge and experience to provide medical interpretation and determinations as to whether the services requested by the patient’s physician meets the patient’s healthcare plan’s criteria as well as nationally accepted clinical guidelines. Reviews may require engaging in peer-to-peer conversations with treating providers as necessary.

Primary Responsibilities:

• Using critical thinking skills, Medical Directors interpret, evaluate, and analyze facts and information that are available to form judgment in rendering coverage determinations.
• Medical Directors conduct coverage reviews based on individual patient/member plan benefits, and/or national and proprietary coverage review policies, in rendering coverage determinations.
• Interpret existing benefit language and policies in the process of clinical coverage reviews.
• Thoroughly document clinical review findings and outcomes in accordance with policies and regulatory and accreditation requirements.
• Take part in peer-to-peer discussions with prescribing providers, as needed.
• Communicate and collaborate with other Medical Director colleagues.

Benefits

This busy, full-time opportunity allows physicians to work from home. Position includes a comprehensive benefits package. Benefits include healthcare insurance, vision and dental insurance, a 401(k)-retirement plan with a generous company match, 33 days of paid time off per year, and more.

Schedule

Medical Directors work 40 hours per week, 5, 8-hours shifts, or 4, 10-hour shifts (after training), scheduled in staggered shifts between the hours of 6am to 7pm MST (8am – 9pm EST). The schedule includes a weekend rotation, with Medical Directors working 2-3 weekend days per month. 

Schedules are provided at least 60 days in advance. Note: this is not a flexible schedule, Medical Directors are assigned their scheduled hours and must be dedicated to the job during their scheduled hours. Note: we do not have part-time positions available. 

All computer equipment necessary for the position is provided. For security purposes computers must be hard-wired into the internet using an Ethernet cable (Wi-Fi is not permitted). 

Requirements

To be eligible for this position, candidates must meet the following criteria:

• Hold active, unencumbered state licensure as a Medical Doctor (MD/DO), any state.
• Hold current board certification in either Family Medicine or Internal Medicine.
• Possess a minimum of 5 years of direct patient care experience, post training, with the most recent experience no less than 6 months ago (recent clinical care is essential).
• Have recently work in an inpatient/hospital setting.
• Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
• Have a clean background, without prior licensure issues, pending malpractice cases or legal issues.
• Possess excellent verbal and written communication skills.
• Have excellent interpretation skills, divergent/creative thinking skills.

Additionally:

• Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.
• Reviewers are covered under MRIoA’s Errors and Omissions policy.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. 

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