Medical Director-Remote 93996

Description:

Mountain Standard Time

1. What is the specific title of the position? Medical Director
2. Work location ? Remote/telecommute
3. Work hours (ex. 9am-5pm day/night shifts rotating shifts etc)? 8-5 Mountain Time; no nights; rotating weekends (average 2 weekends/month with minimal responsibility)
4. What does this position accomplish for the business?
Medical Director for all lines of RMHP business (Medicaid, CHP+, MA, DSNP, IFP) in the RMHP market only. Scope of work: Utilization Management; Appeals; Quality of Care Concern Determinations and consultations with UM and CM team members around patient care issues.
5. The Medical Director would work primarily with the Utilization Management Team (nurses and coordinators) but would also work with the Appeals coordinators and various times with Care Management team members in discussing cases. The position is for the primary (full time) Medical Director. The team also includes a part time Medical Director for overage and vacation coverage.
6. Utilization management reviews (concurrent and retrospective to include peer reviews, as necessary); Appeals (determination of appeals if not the decision maker on the original UM decision); QOC investigations (review findings from QOC nurse to determine if standard of care was met; if there it is not met, issue findings and present the member case to peer review)
7. What does the ideal candidate background look like (ex: healthcare specific background specific industry experience etc.)? The ideal candidate needs to be very comfortable clinically. History of utilization management reviews is very helpful but not necessary. Primary care background is preferred or specialty, with primary care education. [Behavioral health is not desired; the health plan already has sufficient BH medical direction.]
8. What skills/attributes are required (please be detailed as to number of years of experience for each skill)? 5+ years of clinical practice; good communication skills (ability to have tough conversations and not become emotional; example: talking to a provider about a certain request not meeting medical necessity—staying calm and having a discussion/not argument); ability to work in and with teams (across the organization—utilization management, case management, appeal teams).
9. What skills/attributes are preferred (what will set a candidate apart)? Professionalism and communication skills; ability to have sometime tough conversations and not be drawn in emotionally
10. Does this position require a professional license or certification? If so please list. Must have a COLORADO medical license.
11. What is the dress code (ex: business casual scrubs etc.)? Usually off of video; if in meetings, business casual
12. How would you prefer to interview? (Video phone or in person? How many rounds?) Video—would expect 1 round; possibly 2 rounds (with UM leaders)