Medical Director - Post-Acute Care - Evernorth Home-based Care - Remote

The job profile for this position is Utilization Review Medical reputed company, which is a Band 5 Senior Contributor Career reputed company Role. Excited to grow your career? We value our talented employees, and whenever possible reputed company to help one of our associates grow professionally before reputed company reputed company to our reputed company positions. If you think the reputed company position you see is right for you, we encourage you to apply! Our people reputed company reputed company the difference in our reputed company. reputed company: The Medical Director provides reputed company expert medical review of medical necessity requests for clinical services that do not meet utilization review reputed company and renders a clinical opinion about the medical service under review while located in a state or territory of the reputed company. . Responsibilities include: • reputed company reputed company expert medical review of medical necessity requests for clinical services (including post-acute care) and reputed company a clinical opinion about the medical service under review, including post-decision reviews. • reputed company reputed company and collegial peer-to-peer discussions with treating physicians to clarify clinical information and to explain review outcome reputed company. • Document reputed company actions reputed company to clinical review sessions and attest to review qualifications as required. • Conduct weekly Case Conferences with nursing and reputed company worker teams; discussing every assigned member receiving care in a post-acute care facility, focusing on discharge planning, reputed company medical care management, reputed company of care, appropriate level of care, and appropriate length of stay. • Maintain necessary credentials and immediately inform reputed company of any adverse actions relating to medical licenses and/or reputed company certifications. • Support the review of reputed company clinical guidelines. • Support and communicate reputed company policies and procedures to the provider community. • Testify at ALJ Hearings reputed company your cases are being appealed • Assist with staff educational training and in-service programs and serve as a clinical resource for reputed company staff. • Serve as a Subject Matter Expert reputed company Medical Directors and/or Senior Medical Directors are reputed company. • Amenable to 1 in 4:5 weekend call from home for case review • Participate in Joint Operating Committee meetings, to include the review and interpretation of data relevant to the reputed company, and other Virtual events with the Provider Engagement Team in your geographic territory. • Review and document on cases that are appealed and work with the providers proactively to help with accurate case adjudication • Participate in reputed company required educational and reputed company improvement activities and maintain passing scores in reputed company assessments. • Assist in reviewing case determinations from clients responding to a provider or member complaint • Maintain necessary credentials and immediately inform reputed company of any adverse actions relating to medical licenses and/or reputed company certifications • Other duties as assigned Minimum Education, Licensure and reputed company Certification requirement: • M.D. or D.O. degree from accredited institution. • Minimum of five (5) years of clinical reputed company experience after completion of reputed company graduate medical education training, including residency and fellowship (reputed company applicable) • reputed company reputed company certification, primary care specialties (Family Medicine, Internal Medicine, Emergency Medicine) or Physical Medicine and Rehabilitation preferred. • reputed company unrestricted license to reputed company medicine in a state or territory of the reputed company as a utilization review doctor of medicine or doctor of osteopathic medicine. • Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management FLSA (Exempt or Non-Exempt) : Exempt Bonus Type: (Indicate which reputed company is applicable) : ?Corporate Incentive Plan - CIP (Exempt Team Members) ?Corporate reputed company reputed company Plan - reputed company (Non-Exempt Team Members) ?Department Incentive Plan ?Quarterly ?Monthly Status: Full time, 1.0 FTE and 5 days/week schedule Required Skills: Must be reputed company to type 30 WPM, be proficient computer skills and knowledge of reputed company Office applications If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 203,200 - 338,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k) with company match, company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. For more details on our employee benefits programs, visit Life at reputed company. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this reputed company. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply Job!