REMOTE – Medical Director Remote Full-Time Work from Home

A leading healthcare organization is seeking an experienced Medical Director of Prior Authorization to support its provider network. This Physician Leader will help ensure patients receive the right care at the right time and in the appropriate setting through medical necessity review, care coordination, and strong provider relationships.

Key Responsibilities

• Review pre-service authorization requests using evidence-based clinical guidelines and organizational policies.
• Make determinations regarding approvals, denials, modifications, and redirection of care
• Collaborate with physicians, nurses and clinical coordinators to provide high-quality, cost-effective care
• Conduct retrospective inpatient and outpatient clams reviews

Qualifications

• Doctor of Medicine (MD or DO0
• Active CA license
• At least 2 years of clinical experience
• Two plus years of managed care, health plan, UM or Prior Auth experience preferred
• Board certification preferred; board-eligible will be considered
• Evaluating complex clinical information and making sound medical-necessity decisions

Tagged as: Advisor, Medical Director, Physician Advisor