Medical Director- Utilization review

Location: TX
Job Type: Direct Hire
Salary: $195,000.00 - $195,000.00
Date: 4/11/2017
Job ID: 02471644
Job Description
We are in search of a Medical Director who is Board Certified as a Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine). Board Certification must be through an approved ABMS Board. 
To be considered you must be an actively practicing physician who is perhaps in the 3rd or 4th quarter of your career and is looking for a change to be working in Utilization Review.  This position offers great work/life balance. No more Call and no more weekends and you can work from home.
Regional relocation is available. Our client is located in south central Texas… so you would need to live in the region, however the position offers you the opportunity to work remote. There is a Performance Bonus of 20% or possibly higher. Since the work you would be doing will involve Utilization review work in multiple states, it is required you do not have a restricted license. You will not have any direct reports in this role. Salary starts at $ 195,000
Our client provides health insurance solutions for the under-insured and uninsured, and through specialty services. Our client is a firm believer in focusing on the whole health of a person.
It is a plus if you have the following, but NOT required: Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.
In this role :
  • you have the opportunity to utilize all of your years of clinical practice to assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. This includes health plans through Medicaid, Medicare and the Health Insurance Marketplace.
  • You will oversee the activities of physician advisors who are reviewing complex cases and medical necessity appeals.
  • You will perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. You could be reviewing claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
  • Identify and implement clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
  • Our client offers outstanding health insurance benefits: paying most of your benefits costs and in some cases – pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
  • 401(k) retirement with company match and Employee stock purchase plan
They also offer:  Vacation, Personal and Sick time, Paid Company Holidays , Employee Assistance Program (EAP),  Training and Learning Opportunities,  Tuition Reimbursement/Educational Assistance , On-site fitness center or discount at local fitness centers (most locations),  Discounts for select local and national products and services, including cell phones, computers and more.

Please email us your resume along with the best days and times to reach you. We look forward to discussing this exciting and rewarding opportunity.