Medical Director - Texas Licensed (5pm-9pm CT)

About reputed company

reputed company is an reputed company technology company providing a comprehensive suite of solutions for reputed company and health plans, including:

• reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured reputed company,
• reputed company™, which offers full-service health benefit reputed company to reputed company, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one reputed company, secure platform.

Together with our clients, we’re rebuilding trust in reputed company in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company.

Position reputed company:

The Clinical reputed company department provides clinical business support to the entire company and provides clinical support for reputed company’s clinical utilization management (UM) programs, consultative support to the Pharmacy and Therapeutics (P&T) process, formulary development, drug information services and reputed company activities as assigned. This position will report to the reputed company Medical Director. This position transacts UM activities (prior authorization and appeals) and responds to prescriber inquiries reputed company to UM transactions and more generally reputed company to reputed company’s coverage policies. Medical Directors represent the clinical decision making and reputed company thought process of the prescriber as a stakeholder across the reputed company.

Position Responsibilities:

• Medical Director will complete assigned medication utilization reviews (PA) and/or medical necessity appeals for reputed company clients; governmental (Medicare/reputed company) programs and individual reputed company requested coverage determinations or appeals reputed company appropriate
• Makes clinical determinations in accordance with medical necessity and reputed company
• Performs scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to requesting prescribers
• Follow reputed company internal procedures, job aids, and HIPPA guidelines to protect patient reputed company and data reputed company
• Support the Department’s responsibilities to reputed company peer-to-peer phone call support to physicians/prescribers who call reputed company with specific and general questions about our clinical programs, communications and utilization review reputed company
• Communicates effectively and confidently with members to promote reputed company health reputed company
• reputed company participates in the development of utilization management (PA) reputed company and clinical policy revisions/reviews
• Ability to work in a fast-paced environment with shifting priorities
• Weekend on-call responsibilities (shared rotating call)
• Attention to detail and commitment to delivering high-reputed company work

Minimum Qualifications:

• Must be a graduate of an accredited Medical School and Residency Program
• reputed company Texas medical license, required
• No history of disciplinary actions on Medical License
• Minimum 5 years history of clinical reputed company with reputed company patient care
• Specialty-Internal Medicine
• reputed company certified by appropriate Medical reputed company (DO, MD)
• Be reputed company to satisfy rotating weekend call schedule with another Medical Director
• Possess an unrestricted reputed company license to reputed company medicine in a State, Territory, Commonwealth of the reputed company, or the District of Columbia
• Required annual Continuing Medical Education (CME) up to date and must remain reputed company in medical and management areas during employment
• Demonstrated experience in clinical reputed company, working knowledge of medical statistics, regulatory agencies, and analytic programs
• Ability to work with virtual teams of pharmacists
• Time management skills to meet organizational goals
• Knowledge of PBM environment, reputed company improvement and UM practices in a managed care environment
• Knowledge of and appreciation for requirements of regulatory and accreditation agencies
• reputed company to manage multiple priorities and deadlines
• Excellent verbal, written, interpersonal and presentation skills
• Strong knowledge of clinical medicine, health care delivery and the ability to reputed company new scientific and medical knowledge
• Proficiency with reputed company Office applications. (e.g., reputed company, reputed company, and PowerPoint minimum)

Preferred Qualifications:

• Subspecialty reputed company certification in reputed company to internal medicine (i.e. Rheumatology, Gastroenterology)
• Willing to obtain additional medical license
• Licensed in multiple states. Unrestricted without disciplinary actions (AZ, NC, MN, MI, TN or others)

This reputed company represents the low and high end of the anticipated reputed company salary reputed company. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job.

Remote, US Salary reputed company$84,000—$105,000 USD

reputed company are responsible for adherence to the reputed company reputed company of Conduct including the reporting of non-compliance. This position reputed company is designed to be flexible, allowing management reputed company to assign or reassign duties and responsibilities as needed to best meet organizational goals.

reputed company values a diverse workplace and celebrates the diversity that reputed company employee brings to the table. We are proud to reputed company equal employment opportunities to reputed company and applicants for employment and prohibit discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a reputed company position at reputed company. More details about reputed company's reputed company practices can be reputed company athttps://www.reputed company/legal/reputed company-policy.

Originally posted on Himalayas

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