Medical Director - Utilization Review
The Medical Director is a board certified physician with strong clinical, administrative and management experience. General duties include providing clinical expertise, medical interpretation and decisions about appropriateness of services, collaborate with Physician Advisors/Consultants, provide oversight to their review process, work collaboratively with Compliance and Quality on system initiatives and coordinate with physician leaders in counseling medical staff in a manner consistent with the medical staff bylaws.
- Prior Authorization
- Concurrent Review
- Retrospective Review
- Clinical Practice Guidelines
- Medical Technology Assessment
- Case Management/Case Coordination
- Disease/Chronic Illness Management
- Drug Utilization Review
- Data Analysis and reporting
- Preventive Health Program
- Transplant Management
- Strict adherence to production timeline
- Special projects as assigned
This is a 100% administrative position. M-F that offers a great work-life balance.
Candidates must have a current Arizona license to practice medicine without restrictions.
Medical Doctorate or Doctor of Osteopathy degree required
3 to 5 years medical administrative experience preferred with an emphasis on Managed Care Members and Medicare rules and regulations
Strong/creative UM experience and realistic approach to case management
Excellent communication skills and ability to interact with all levels of management, physicians, staff, health plan representatives and outside agencies
For more information, please email a copy of your CV today!