National Medical Director

2 months ago

Virginia, United States CorVel Full time

The Medical Director guides and directs the CorVel clinical operations including Case Management, Utilization Management, and Provider Networks. The Medical Director ensures services delivered are the highest quality and meet the standards of CorVel, URAC and State regulations. The Medical Director contributes to CorVel’s operational excellence by supporting the organization’s mission to provide efficient, effective and compassionate care. This is a contracted, part-time position. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Clinical Leadership : Provide clinical oversight and leadership to the medical management teams, including physicians, nurses and other healthcare professionals. Care Coordination : Develop and implement care management protocols and policies to ensure timely and appropriate medical care for patients. Utilization Review : Oversee the utilization review process to ensure medical necessity, appropriateness and cost-effectiveness of healthcare services. Quality Assurance : Establish and maintain quality assurance programs to monitor and improve the quality of care provided to patients. Acts as the chairperson of the National Credentialing and Quality Assurance Committee. Regulatory Compliance : Ensure compliance with all federal, state, and local regulations related to workers’ compensation and managed care. Stakeholder Collaboration : Work collaboratively with internal and external stakeholders, including employers, insurers, healthcare providers, and regulatory agencies, to facilitate coordinated care. Training and Education : Develop and deliver training programs for clinical staff on best practices in workers’ compensation care and regulatory requirements. Clinical Documentation : Oversee the development and maintenance of accurate and comprehensive clinical documentation and records. Performance Metrics : Monitor and analyze key performance metrics to assess the effectiveness of medical management programs and identify areas for improvement. Legal Expert : Provide testimony or depositions when requested. KNOWLEDGE & SKILLS: Demonstrated experience in a leadership or management role within a healthcare organization. Strong understanding of workers’ compensation laws, regulations, and best practices. Must have a thorough knowledge of both CPT and ICD coding. Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers. Excellent written and verbal communication skills, with the ability to interact effectively with diverse stakeholders. Strong analytical and problem-solving skills, with the ability to make data-driven decisions. Ability to meet designated deadlines. Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets. Ability to build and maintain effective working relationships with colleagues, providers, and external partners. Strong interpersonal, time management and organizational skills. Ability to work both independently and within a team environment. Thorough knowledge of ICD and CPT coding. EDUCATION/EXPERIENCE: Active, unrestricted doctor of medicine or doctor of osteopathic license or certification to practice medicine in a state or territory of the United States. A valid medical degree from an accredited institution. Board certification in a relevant specialty such as occupational medicine. Minimum of 20 years of clinical practice experience, preferably in occupational medicine, workers’ compensation, or managed care settings. Demonstrated experience in a leadership or management role within a healthcare organization. PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #J-18808-Ljbffr

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