Medical Director

    • Job Tracking ID: 762429
    • Job Location: Springfield, IL
    • Job Level: Management
    • Level of Education: Masters Degree
    • Job Type: Part-Time
    • Date Updated: April 09, 2021
    • Years of Experience: 10 - 15 Years
    • Starting Date: ASAP
    • Salary Type:: Hourly
    • Rate:: $115-$150/hour + DOE
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Job Description:

$115-$150/hour + DOE; PT 15-20+ hours per week

Job Summary

The Medical Director conducts member case reviews requiring physician involvement such as prior authorizations, post service reviews, and appeals. Provides peer-to-peer consultations with providers and clinical expertise to staff on case management reviews. Provides leadership for employed or contract physicians and participates on clinical committees/project teams.

Key Result Areas

  • Conducts high-quality member case reviews and/or appeal case reviews.
  • Provides peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations.
  • Supports the medical management staff ensuring timely and consistent responses to members and providers
  • Participates in various meetings to provide clinical input on medical policy reviews and development and may participate on committees that develop programs impacting clinical interventions, utilization management and case management.
  • Ensures compliance with HIPAA and HITRUST information security requirements to protect client information.
  • Adheres to AmeriBen culture by demonstrating Integrity, Initiative, Good Judgment, and Teamwork.
  • Performs other duties as assigned to ensure individual and group goals are achieved with Accuracy, Customer Service and Timely Turnaround.

 

Experience and Skills:

  • Requires M.D. or D.O
  • Must possess an active unrestricted medical license to practice medicine or a health profession.                                                                                                                                                    
  • Board Certification approved by the American Board of Medical Specialties required where applicable to duties being performed.
  • 5+ years of clinical experience or any combination of education and experience which would provide an equivalent background.
  • Strong verbal and written communication skills.

 Preferred Qualifications

  • Utilization Review and/or Managed Care experience preferred.
  • Proficiency with Microsoft Office products.
  • Knowledge/understanding of determining medical necessity, utilization review principles, and Continuous Quality Improvement theory and practice.
  • Experience with performance measurements (HEDIS, NQF and other systems),

AmeriBen is an Equal Opportunity Employer committed to creating an environment of diversity and inclusion for equal employment and advancement opportunities to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, national origin, sex, sexual orientation, gender identity and/or expression, genetic information, disability, veteran or military status, or any other category protected by federal, state and/or local law.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If you are unable to use our online application process due to a disability, please contact the Human Resources Department at humanresources@ameriben.com or call 208-488-7654.