About the job
I have a remote opportunity for an experienced Medical Director to support Utilization Management (UM) operations, including pre-certification review and physician-to-physician (peer) consultations with one of Pennsylvania's top clients.
Key Responsibilities
- Conduct Utilization Management reviews, including pre-certification, concurrent review, and retrospective review as needed.
- Perform peer-to-peer discussions with ordering providers to clarify clinical information and determine medical necessity.
- Apply InterQual, CMS guidelines, and other evidence-based criteria to clinical determinations.
- Maintain strict compliance with confidentiality requirements and CMS regulations.
Other Highlights
- yearly earnings $280,000+
- Monday to Friday schedule, no weekends
Required Qualifications
- Doctor of Medicine (MD) or Doctor of Osteopathy (DO) with active, unrestricted Pennsylvania medical license.
- Board Certified in Internal Medicine.
- Minimum 2+ years of Utilization Management experience, including pre-cert and peer review.
- Demonstrated experience using InterQual criteria and CMS medical necessity guidelines.
- Must reside in PA, NJ, or DE.
- Must not be concurrently employed or consulting with Jefferson or Penn.
APPLY NOW.
