This is a full time position supporting the Nevada Medicaid team. Telecommuting from locations within the US may be considered.
Responsible for providing day to day guidance, support, and leadership for the clinical and quality activities and supporting the Medical Director in ensuring the clinical integrity of broad and significant clinical programs and identifies and develops opportunities for innovation to increase effectiveness and quality. Primary duties may include, but are not limited to:
Provides support to clinicians in daily tasks and ensuring timely and consistent responses to members and providers, conducts peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations, office visits with providers and external physicians as necessary.
May participate in a physician on-call rotation for a 24x7 pre-certification unit, assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.
Serves as a resource and consultant to other areas of the company and may be required to represent the company to external entities and/or serve on external committees, and conduct peer clinical and/or appeal case reviews and peer to peer clinical reviews with attending physicians or other ordering providers to discuss review determinations.
Requires M.D. or D.O.
Current Board certification approved by the American Board of Medical Specialties required
Must possess an active unrestricted medical license to practice medicine in the State of Nevada.
5 years of clinical experience or any combination of education and experience, which would provide an equivalent background.
2 years of experience with utilization review preferred.
Title: Associate Medical Director - 122233
Requisition ID: 122233
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