Medical Director

2 weeks ago

charlotte, United States TPI Global Solutions Full time

Job Title: Medical Director

Location: Remote (company based in Charlotte)

Direct Hire: Part-time (4hours a day/20hrs a week)




PT - fully remote part time position (4hrs a day/20hrs a week)

What will you be doing:

  • The Medical Director is responsible for processing UM requests that do not meet guidelines, processing appeals, education of the ordering providers in peer-to-peer calls.
  • The Medical Director is also responsible for review of criteria yearly.

Required Qualifications

Work Experience ( do not edit ):

  • Minimum of 7 years of experience in practice in direct patient care after graduating from medical school


Skills & Experience ( top 3 skills ):

  • Strong clinical, management and organizational skills.
  • Excellent verbal and written communications skills
  • Proficient computer skills


Certification/License:

  • Current, unrestricted medical license in required specialty
  • Board certified in required specialty


Education:

Graduate of recognized medical degree program

Preferred Qualifications

Relevant Experience to include:

  • Knowledge of regulatory requirements

  • Responsible for processing UM requests, appeals, and reconsiderations. Required to write a denial rationale in compliance with health plan, government agencies, and accrediting bodies.
  • Required to be compliant with contractual obligations to the health plans and government agencies, as well as requirements consistent with active certifications/accredations.
  • Required to participate in quarterly UM meetings
  • Responsible for identifying educational needs and participating in ongoing education and support for the medical and intake staff.
  • Responsible for acting as a clinical liaison to providers, clients, and members as directed by the Chief Medical Officer
  • Responsible for communicating need for additional clinical information to referring/prescribing providers related to consideration for authorization or modification of a referring provider’s request for radiological or diagnostic imaging services.
  • Required to collaborate with management to create and implement new process or quality improvement initiatives

Responsible for coordinating with UM Intake Specialists to ensure timely and accurate communication of clinical decisions

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