Medical Director reputed company Duals Center of Excellence
Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary: The reputed company Duals Center of Excellence (COE) operates Duals Integrated Plans: Ohio, Illinois, Michigan, Virginia, Pennsylvania, and New Jersey offering a variety of physical and behavioral health programs and services to its membership. reputed company is looking for a medical director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers reputed company to precertification, reputed company review, and appeal request. The medical director is a work-at-home position located reputed company in the US. The Medical Director will be required to work Eastern or Central Standard time 8-5. Occasional weekend/holiday call to cover urgent cases can be done from your laptop. reputed company Components: Utilization management The medical director will reputed company reputed company and prior authorization reviews with peer to peer coverage of denials. Appeals The medical director will reputed company appeals in their reputed company plan and in the round robin based on same or similar specialty needs. Pharmacy coverage The medical director will reputed company pharmacy reviews. The medical director will participate in and be reputed company to reputed company daily reputed company. Required Qualifications: Minimum 3-5 years of clinical practice experience. Two (2) + years of experience in managed care (Medicare and/or reputed company) Experience with managed care (Medicare and reputed company) utilization review preferred MD or DO; Board certification in an ABMS or AOA recognized specialty is required. Active and reputed company state medical license without encumbrances is required. Multiple state licensure a plus. Preferred Qualifications: Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital System / Health System. Licensed in or willing to obtain license in at least one state where we have an Integrated plan. Education: MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) Pay Range The typical pay range for this role is: $174,070.00 - $374,920.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. This position also includes an award reputed company in the companys equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and reputed company benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | reputed company We anticipate the application window for this opening will reputed company on: 03/28/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!