Medical Director – Physical Health
Alliance Health
full-time
Posted on:
Location Type: Hybrid
Location: Charlotte • North Carolina • United States
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Salary
💰 $211,172 - $269,245 per year
Job Level
About the role
- Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care.
- Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services.
- Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards.
- Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service.
- Process adherence to complete timely utilization reviews in Alliance’s UM platform and perform tasks efficiently.
- Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee.
- Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services.
Requirements
- Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field.
- At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required.
- Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine.
- Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
- Knowledge of Managed Care Principles.
- Knowledge of recent developments in the field of medicine.
- Microsoft Office Skills.
- Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations.
- Utilization Management experience.
Benefits
- Medical, Dental, Vision, Life, Long Term Disability
- Generous retirement savings plan
- Flexible work schedules including hybrid/remote options
- Paid time off including vacation, sick leave, holiday, management leave
- Dress flexibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization managementmedical necessity criteriaclinical case reviewsmanaged carediagnosis and treatment techniquespreventive health-care measureslevel of care determinationauthorization of servicesinpatient servicesoutpatient services
Soft skills
communicationcollaborationproblem-solvingleadershiporganizational skillscritical thinkinginterpersonal skillsactive participationbest practice recommendationscase management
Certifications
M.D. degreeD.O. degreeboard certificationNorth Carolina Medical License