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Medical Director - Utilization Management (Remote)

Role overview

Qualifications

  • Minimum of five years’ full-time equivalent experience providing direct clinical care to patients
  • Minimum of five years’ experience administering utilization management and peer review programs preferred
  • MD/DO degree
  • Current, unrestricted medical license as required for clinical practice in a state of the United States

Responsibilities

  • Perform utilization management case reviews.
  • Maintain productivity score per company standard.
  • Complete annual inter-rater reliability testing.
  • Demonstrate respect in interactions across the company.

Key facts

Other skills

  • Communication
  • Teamwork
  • Time Management

About the company

Medical Review Institute logo

Medical Review Institute

Medical Review Institute of America, LLC (MRIoA) was incorporated in 1983. Today MRIoA is an industry leader in providing external review resources for over 800 clients nationwide. MRIoA provides review of medical, dental, behavioral health, pharmacy, vision, disability, workers'​ compensation, and auto claims for insurance carriers, employers, TPAs, self- administered union groups, pharmacy benefit managers, human resource consultants and departments of insurance throughout the country. MRIoA utilizes a nationwide network of board-certified physician specialists and professionals in over 133 specialties and sub-specialties of medicine. MRIoA also has reviewers in most states, offering the most extensive same-state reviewer resources available from an external review organization. MRIoA holds dual accreditation with URAC with certificates in Health Utilization Management and as an Independent Review Organization. In addition we are NCQA and SSAE 16 certified.MRIoA's goal is to render a professional, independent and unbiased opinion to assist our clients with their adjudication challenges or to provide an external source to comply with ERISA/DOL or state laws.MRIoA reviews cases prospectively, concurrently and retrospectively for: Medical Necessity, Appropriate Treatment, Experimental Procedures, Utilization Frequency, Appropriate Hospitalization, Formulary Criteria Review, Pre-Existing Conditions, Injury Causation, CPT Coding, Level of Disability, Provider Fees, Outpatient Facility Fees, and all Diagnostic Testing and Charges.MRIoA has provided state-level external review in many states since 2001. MRIoA is also contracted with hundreds of clients to offer Federal External Review under the ACA.

Company details

Company typeSME
Company size201 - 500

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Job description

Description

Who We Are - Motivated by Purpose. Powered by Clinical Expertise.


Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.


Excellence starts with our people.


WE OFFER

  • A competitive compensation package
  • Benefits include healthcare, vision, and dental insurance
  • A generous 401(k) match
  • Paid vacation, PTO, and holidays
  • Growth and training opportunities
  • An award-winning remote work environment


Position Summary

Our Medical Director, also known as a Physician Advisor, is responsible for performing clinical utilization management, peer review activities, and clinical quality management activities.


Key Responsibilities

  • Perform utilization management case reviews.
  • Maintain productivity score per company standard.
  • Maintain annual quality score per company standard.
  • Complete annual inter-rater reliability testing.
  • Train across all queues as requested by MRIoA leadership.
  • Complete all client specific training as requested by MRIoA leadership.
  • Maintain up-to-date records of case completion if required
  • Consistently show willingness to take cases as requested.
  • Demonstrate respect in interactions across the company.
  • Consistently submit scheduling requests at least three months in advance. Consistently work scheduled hours.
  • Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company).
  • Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team.
  • Actively participate in the MRIoA evaluation process (both company and individual).
  • Participate in all company meetings and committees as requested.
  • Complete other duties as requested or approved by the CEO and/or chief medical officer.
  • Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards


Work Schedule

  • 40 hours per week
  • Five 8-hour shifts or four 10-hour shifts (available after training)
  • Shifts scheduled between 6:00 AM – 7:00 PM MST
  • Includes 2–3 weekend rotating shifts per month
  • Schedules are fixed and released 60 days in advance


Compensation & Expanded Benefits

  • Base salary: $240,000 per year
  • 20 days of Paid Time Off per year
  • 6 company Holidays (New Year’s, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas) and 1 Floating Holiday
  • 8 days of Paid Sick Leave
  • Medical and Prescription Benefits administered by Aetna
  • Dental and Vision benefits
  • Basic Life and Accidental Death and Dismemberment (AD&D) Insurance
  • Short-Term & Long-term Disability insurance


Requirements


Skills and Experience

  • Minimum of five years’ full-time equivalent experience providing direct clinical care to patients
  • Minimum of five years’ experience administering utilization management and peer review programs preferred
  • Credentialed and privileged by the Company's Credentialing Committee
  • Obtain additional state licensure as required for the position


Education:

  • MD/DO degree
  • Current, unrestricted medical license as required for clinical practice in a state of the United States
  • Board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) or other board recognized by URAC preferred


Additionally:

  • Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy.

 

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).


Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.  Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.


California Consumer Privacy Act (CCPA) Information (California Residents Only):

  • Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
  • Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com. 


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Marcus Rivera

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