Medical Director/Physician Advisor

Remote MT Helena 59601

Remote position available

Job Description

Primary responsibility is to make independent medical necessity and appropriateness decisions and to provide independent medical consultation to Magellan medical and care management staff.
  • Provides independent peer review activity function, including review for medical necessity, level of care, quality, and appropriateness of care.
  • Provide clinical rationale for all initial decisions as well as standard and expedited appeals.
  • Reviews are performed by speaking directly with clinicians and/or by reviewing clinical records.
  • Provides peer-to-peer discussions with ordering providers and their staff when requested as well as guidance and education on guidelines to improve the quality of future requests.
  • Performs second level of review for second opinions and appeals as requested.
  • Documents all communication with medical office staff and/or physician provider in a timely and accurate manner.
  • Offers expert consultation and advice to formal committees as recommended by the Medical Director.

General Job Information

Title

Medical Director/Physician Advisor

Grade

32

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

8/19/2019

Date Requisition Created

8/19/2019

Work Experience

Medical

Education

MD (Required)

License and Certifications - Required

DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Must hold current, active license to practice medicine in the United States.
  • Licensure must be for independent practice and be unencumbered by sanctions, practice restrictions or other disciplinary actions. 
  • Must hold licensure or be license eligible in state of operation.
  • Licensure must be complete within the 1st year of employment.
  • In addition, hold an active license to practice medicine in the state where required to conduct utilization review activities, if required for the position.
  • Must be board-certified in a medical specialty by the American Board of Medical Specialties (ABMS) or by a specialty affiliate of the American Osteopathic Association (AOA).
  • Post-residency experience of at least 5 years involving substantial direct patient care during this period at multiple levels of care.
  • Graduate of an American or Canadian medical school accredited by the Accreditation Council for Medical Education (ACME) or equivalent training in a foreign medical school with successful completion of the ECFMG and FLEX examinations.
  • Full training in a residency program in the United States or Canada that is approved by the ACGME.

Managed care experience as a provider and a manager of care. Utilization Review or Physician Advisor experience preferred. Accreditation experience (NCQA, AAHCC/URAC) preferred.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”