Medical Director for Gastroenterology Care Management
6 days ago
About eviCore healthcare
">We are a leading healthcare company dedicated to delivering high-quality medical reviews and care management services. Our team is passionate about making a positive impact on healthcare, and we strive to create a supportive environment that fosters growth and collaboration.
">Job Summary:
">We are seeking an experienced Medical Director for our Gastroenterology Care Management team. As a key member of our team, you will be responsible for providing timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria. Your clinical expertise and knowledge will play a critical role in ensuring that our patients receive the highest level of care.
">Key Responsibilities:
">- Provide timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria.">
- Conduct peer-to-peer discussions with referring physicians to clarify clinical information and explain review outcome decisions.">
- Maintain necessary credentials and inform eviCore of any adverse actions relating to medical licenses and/or board certifications.">
Requirements:
">- MD or DO with a current, active, U.S. state medical license and board certified in Gastroenterology, recognized by the American Board of Medical Specialties (ABMS).">
- Recent practice experience in direct patient care (within the past 18 months).">
- A minimum of 5 years clinical experience, beyond residency/fellowship.">
- Knowledge of applicable state and federal laws, URAC and NCQA standards.">
- Familiarity with automated processes and computer applications and systems.">
What We Offer:
">- Predictable work schedule with no nights, weekends, or call.">
- Full and part-time opportunities available.">
- Salaried position with benefits, including flexible scheduling and work-life balance.">
- Education assistance, tuition reimbursement, and professional certification support.">
- Health, dental, vision, and life benefits with employer-funded HSA.">
- Ample opportunities for growth, advancement, and promotion.">
- 401(k) retirement plan with company match of 50% employee contributions up to 6%.">
Estimated Salary: $200,000 - $250,000 per year
">Location: California
">Original Language Code: en
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