Medical Director Therapy
Core
Review clinical information to determine the medical appropriateness of therapy services (PT/OT/SLP) using evidence-based guidelines.
Role type
Senior Medical Director (Utilization Review)
Builds
Clinical decision guidelines and evidence-based review outcomes for health plans
Domain
Healthcare / Managed Care / Utilization Review
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
PM&R, Family Practice, Pediatrics, or Internal Medicine expertise; Board certification (MD/DO); 5+ years clinical practice; Understanding of Therapy programs (PT/OT/SLP); Managed care regulatory knowledge; Peer-to-peer discussion facilitation
Preferred skills
1+ years managed care utilization review experience in Therapy; Licensure in AR, MO, MN, NC, IN, TX, NE
Technologies
Cohere workflow tools; Clinical decision support platforms
Responsibilities
Review clinical information and apply evidence-based guidelines to determine medical necessity; Provide expert input on clinical content to influence physician care; Conduct timely peer-to-peer discussions with treating providers; Document medical necessity decisions accurately; Support team projects on clinical expertise and operational improvements
Seniority
Senior, hands-on IC