Medical Director, Post Acute Care
Core
Provide evidence-based medical reviews for patient care, including time-sensitive case reviews and peer-to-peer physician consultations to determine medical necessity and appropriateness of services.
Role type
Senior clinical decision-maker (Medical Director)
Builds
Evidence-based medical necessity determinations for patient care pathways
Domain
Healthcare / Utilization Review / Post-Acute Care
Required skills
Clinical judgment, Evidence-based medicine knowledge, Physician consultation skills, Regulatory compliance knowledge, Medical specialty expertise (PM&R, Family Medicine, Emergency Medicine, Internal Medicine)
Preferred skills
Utilization Review Accreditation Commission standards knowledge, National Committee for Quality Assurance standards knowledge
Technologies
Case management software, Encrypted workstations, Broadband internet systems
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, Ensure compliance with state and federal laws
Seniority
Senior, hands-on IC