Medical Director – Otolaryngology – Evicore - Remote
Remote
Core
Deliver evidence-based medical reviews and conduct peer-to-peer physician consultations to determine medical necessity for Otolaryngology cases.
Role type
Senior clinical decision-maker (Otolaryngology)
Builds
Evidence-based medical necessity determinations for patient care
Domain
Healthcare / Utilization Review
Deliverable
client delivery
Required skills
Clinical judgment, Evidence-based decision making, Physician consultation, Regulatory knowledge, Technology proficiency
Preferred skills
Knowledge of URAC and NCQA standards
Responsibilities
Review medical cases for evidence-based medical necessity, Conduct peer-to-peer calls with referring providers, Recommend alternative services or treatments, Collaborate with physician colleagues on care decisions
Seniority
Senior, hands-on IC