medical director.

Top National Healthcare company is hiring Licensed Medical Doctor to work Remote as a Medical Director.

***Experience as a hospitalist is requested***

The Medical Director for Utilization Management will support management by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to utilization management program.

Essential Job Functions

Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values.

Remain current and proficient in CMS criteria hierarchy and organizational determination processes

Participates in case review and medical necessity determination.

Maintain proficiency in compliance regulations for both CMS and delegated health plans.

Conducts post service reviews issued for medical necessity and benefits determination coding.

Assists in development of medical management, care management, and utilization management protocols.

Performs all other related duties as assigned.

Customer Service

Oversees and ensures physician compliance with UM plan.

Performs all duties in a professional and responsible manner.

Responds to physicians and staff in a prompt, pleasant and professional manner.

Respects physician, patient, and organizational confidentiality.

Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met.

Required Qualifications:

Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.

Board certification in Family Medicine or Internal Medicine

An active, unrestricted medical license (any state)

Five or more years of post-residency clinic practice experience

Proficiency with Microsoft Office applications

Preferred Qualifications:

Two or more years of experience in utilization management activities

Two or more years of experience with acute admissions

Two years of experience working in a managed care health plan environment

Bilingual (English/Spanish) fluency

Contract to start with long term or perm potential.


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.