Field Medical Director, Vascular Surgery
Core
Field Medical Director specializing in Vascular Surgery supporting clinical quality and appropriate healthcare utilization through expert medical reviews of complex cases.
Role type
Senior IC medical director (utilization management)
Builds
Clinical guidance on medical necessity, treatment decisions, and appeals for vascular surgery cases
Domain
Healthcare / Utilization Management
Required skills
Vascular surgery expertise, clinical judgment, peer-to-peer discussion, medical necessity review, regulatory compliance, guideline interpretation, documentation, team collaboration
Preferred skills
Board certification in Vascular Surgery or General Surgery, 5+ years clinical experience, utilization management experience, healthcare accreditation standards familiarity
Technologies
Digital clinical review systems, communication software
Responsibilities
Serve as specialty medical reviewer for non-compliant vascular surgery cases; Conduct clinical assessments and provide expert recommendations; Participate in peer-to-peer telephone discussions with physicians; Provide clinical rationale for standard and expedited appeals; Apply established medical review guidelines and utilization management procedures; Ensure compliance with URAC and NCQA requirements; Act as clinical resource for initial reviewers; Maintain accurate documentation of communications; Participate in ongoing training and inter-rater reliability activities; Support Senior Medical Director with research and guideline interpretation; Assume Medical Director responsibilities for selected health plans or regions when requested
Seniority
Senior, hands-on IC