Associate Medical Director - Outpatient Rehab
Core
Clinical Operations Associate Medical Director supporting medical management staff in outpatient rehab utilization management and case reviews.
Role type
Associate Medical Director (Outpatient Rehab Utilization Management)
Builds
Medical necessity determinations for services, grievance, and appeals for members and providers.
Domain
Healthcare / Utilization Management / Outpatient Rehabilitation
Deliverable
client delivery
Required skills
Board certification (ABMS or AOA), active unrestricted medical license, clinical case review expertise, physician-to-physician communication, medical policy interpretation
Preferred skills
PM&R Board Certification, inpatient or outpatient rehab experience, Microsoft Office Suite
Technologies
Microsoft Office Suite
Responsibilities
Ensure timely completion of clinical case reviews for board-certified specialty; make physician-to-physician calls to gather medical information for necessity determinations; make medical necessity determinations for grievances and appeals; ensure consistent use of medical policies; escalate cases requiring Medical Director review or policy interpretation.
Seniority
Associate, hands-on IC