Medical Director - Utilization Management
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 Statemen