Physician Medical Director

About the Role

We are searching for a dedicated Physician Medical Director to become part of our physician-led team. This position involves delivering expert clinical advocacy to hospitals across the nation by collaborating with payer medical directors to overturn denials and confirm proper patient admission statuses.

Key Responsibilities

• Perform detailed forensic clinical assessments of patient medical records and status decisions.
• Conduct Peer-to-Peer consultations directly with payer medical directors.
• Represent hospitals in challenging inappropriate denials, utilizing evidence-based guidelines.
• Prepare thorough Clinical Advocacy Notes to support legal and compliance documentation.
• Work alongside utilization management teams to enhance clinical operation workflows.

Impact of Your Work

Your efforts will play a crucial role in increasing hospital admission approval rates and recovering revenue lost due to incorrect payer denials, blending clinical expertise with advocacy on a broad scale.

Qualifications

• Board certification in a relevant medical specialty such as Medicine, Surgery, Cardiology, or Pediatrics.
• At least five years of experience practicing clinically.
• Proficient understanding of Milliman, InterQual, and national coverage criteria.
• Strong communication and negotiation abilities.
• Preferred experience in utilization management or working with payers.
• Valid medical license to practice in at least one United States state.

Additional Information

This is a full-time remote position based nationally within the United States. Applicants must have legal work authorization in the U.S. and not require employer visa sponsorship now or in the future. The application requires submission of personal, professional information, and a resume/CV.