Medical Director – Physical Medicine and Rehabilitation
Core
Evaluates high-cost Durable Medical Equipment (DME) requests to determine service appropriateness, primarily within a Medicaid context, and leads clinical operational aspects of the program.
Role type
Director-level Medical Director (Physical Medicine and Rehabilitation)
Builds
Utilization review and appeals processes for DME services
Domain
Healthcare administration, Medicaid, Durable Medical Equipment
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical licensure, Board certification, Utilization review, Clinical policy interpretation, Peer-to-peer review, Program leadership, Cross-functional collaboration
Preferred skills
Utilization management (UM) experience, Board certification in Physical Medicine and Rehabilitation
Technologies
None stated
Responsibilities
Review high-cost DME requests for appropriateness, Provide guidance for clinical operational aspects, Conduct peer-to-peer clinical reviews and appeals, Interpret medical policies and clinical guidelines, Develop and propose new medical policies, Lead and implement clinical and non-clinical activities impacting quality and cost
Seniority
Director, hands-on leadership