Current jobs related to Medical Director - remote us - CareCentrix
-
Medical Director
1 week ago
remote, us Headway Full timeHeadway’s mission is a big one - to build a new mental health care system everyone can access. We’ve built technology that helps people find great therapists with the first software-enabled national network of providers accepting insurance. 1 in 4 people in the US have a treatable mental health condition, but the majority of providers don’t accept...
-
Medical/Clinical Director, Product
4 days ago
remote, us Headway Full timeHeadway’s mission is a big one - to build a new mental health care system everyone can access. We’ve built technology that helps people find great therapists with the first software-enabled national network of providers accepting insurance. 1 in 4 people in the US have a treatable mental health condition, but the majority of providers don’t accept...
-
Medical Director
6 days ago
Remote, Oregon, United States Humana Full time $223,800 - $313,100 per yearBecome a part of our caring community and help us put health firstThe Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals...
-
Medical Director
6 days ago
Remote, Oregon, United States Humana Full time $223,800 - $313,100 per yearBecome a part of our caring community and help us put health firstBecome a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a...
-
Medical Director
15 hours ago
Remote, Oregon, United States Wellness Herbal Spa Full timeMedical Director (MD) – MedSpa Oversight (Remote/Part-Time)Lake Mary, FL – Wellness Herbal Med SpaPart-Time / Remote Oversight RoleAbout Us:Wellness Herbal Med Spa is a growing, modern medspa located in Lake Mary, Florida, specializing in IV therapy, vitamin injections, Botox, dermal fillers, and other rejuvenating wellness treatments. Our mission is to...
-
Director of Medical Science Liaison's
4 days ago
, us CCI Consulting Full timeJob DescriptionThe Director of Medical Science Liaisons will coordinate the activities of the MSL team, ensuring optimal education of the team and strategic direction for their activities. The Director will also be an integral member of the Brand teamFor more detailed information on this postion please go to: http://tinyurl.com/p6a88vqQualificationsAn...
-
Medical Director
3 days ago
Remote, Oregon, United States RUBIE BEHAVIOR SERVICES,INC Full time $10,000 - $20,000 per yearThe Remote Medical Director oversees and guides the clinical operations of the organization from a virtual setting. This role ensures high-quality patient care, regulatory compliance, clinical staff support, and contributes to the development of medical policies and protocols.Key Responsibilities:Supervise clinical practices to ensure quality and patient...
-
Director, Service Delivery
1 week ago
remote us Affirm, Inc. Full timeAffirm is reinventing credit to make it more honest and friendly, giving consumers the flexibility to buy now and pay later without any hidden fees or compounding interest.We are seeking a highly motivated and experienced Director of Service Delivery to join our Operations team! The scope of the Director, Service Delivery includes all customer and merchant...
-
Medical Director
6 days ago
Remote, Oregon, United States CERIS Full time $200,000 - $300,000 per yearJOB SUMMARY:This position will provide medical expertise as a consultant in the development and review of claims review policy. This individual will support CERIS's application of CMS, client and industry standing billing guidelines in circumstances included by not limited to: peer to peer reviews, arbitrations, administrative law hearings and/or mediations...
-
Remote Medical Director Indiana
2 weeks ago
Remote, United States Centene Corporation Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Submit your CV and any additional required information after you have read this...
Medical Director
2 weeks ago
Overview As the Medical Director - Post Acute Care you will provide clinical oversight for one or more CareCentrix markets including Utilization Management reviews of Post-Acute Care (PAC) stay requests, medically appropriate steerage to home, coordination of discharges and post discharge follow up to prevent readmissions. A key part of the role is to work strategically with UM leaders and market engagement directors to overcome facility barriers to discharge. Peer-to-Peer conversations with hospital physicians either pre or post denials, as needed to impact admissions to PAC facilities. Clinical rounds with nurse teams to support PAC length of stay and be available to speak to Appeals in client meetings. In this role, the Medical Director will perform medical necessity reviews utilizing industry standard criteria such as Interqual or MCG and CMS. The primary work will involve PAC facility management including: Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF) and Long Term Acute Care Hospital (LTCH). The Medical Director may also be responsible to develop trainings and quality improvement interventions to support optimal PAC outcomes including readmission prevention program for 90 days post discharge. Responsibilities In this role, you will: Conduct medical necessity reviews adhering to regulatory and compliance turnaround times and issues adverse determinations as needed. Provide guidance to licensed and non-licensed associates on clinical issues and case reviews related to authorization requests and clinical guidelines criteria. Provide education to UM team to support Post Acute Care needs, discharge planning, length of stay management and readmission reduction. Complete peer-to-peer discussions as indicated at the time of PAC facility admissions when medical necessity criteria are not met, to facilitate proactive discharge planning or when facility stay is no longer medically indicated. Participates in CareCentrix Care Coordination, Utilization Management, Quality Improvement and clinical education activities, as requested. Utilize clinical integrity and professionalism in all determinations and interactions with internal and external partners. Collaborate with Account Management and Health Plan clinical leadership as requested. Interface with key positions within CareCentrix including reporting to the Senior Medical Director and interacting with the Chief Medical Officer and executive team members. Collaborate with Market Engagement Directors and facility provider Joint Operations Committee activities as requested/needed. Successfully completes and passes the annual Inter-rater reliability testing and random case audits. Achieves Service Level Agreement (SLA) metrics and performance guarantees as required by health plan clients. Scheduled weekend work is required Qualifications You should get in touch if you have: MD or DO with an active and unencumbered medical license. Must have active ABIM or ABMS specialty board certification(s). The candidate may be asked to obtain additional licenses as needed. Minimum of 5 years’ experience in an area of relevant clinical practice , and prefer at least 3 years’ experience with supporting utilization management reviews, managed care programs or care delivery networks Expertise in the Post-Acute Care field, including current knowledge on best practices, as well as a general knowledge of requirements of regulatory and accreditation standards for payers and health care providers Expertise in Medicaid health plan or UM is preferred Excellent written and verbal communication skills. Interest quality improvement and project a positive attitude toward all assigned work. Adheres to and participates in Company's mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. What we Offer: Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match. Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more. Advancement opportunities, professional skills training, and tuition Reimbursement Great culture with a sense of community. #IDCC CareCentrix maintains a drug-free workplace. We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. Software Powered by iCIMS
