Medical Director – Pediatric Pulmonology – Evicore - Remote
Core
Deliver evidence-based medical reviews and conduct peer-to-peer physician consultations to determine medical necessity for pediatric pulmonology cases.
Role type
Senior clinical decision-maker (Medical Director)
Builds
Evidence-based medical necessity determinations for patient care
Domain
Healthcare / Utilization Review / Pediatric Pulmonology
Deliverable
client delivery
Required skills
Pediatric Pulmonology clinical expertise, Evidence-based medicine judgment, Physician consultation skills, Regulatory knowledge, Technology proficiency
Preferred skills
Utilization Review Accreditation Commission standards knowledge, National Committee for Quality Assurance standards knowledge
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