Medical Director – Physical Medicine and Rehabilitation
Core
Evaluates high-cost Durable Medical Equipment (DME) requests to determine service appropriateness within a Medicaid context and provides clinical guidance for program operations.
Role type
Director-level Medical Director (Physical Medicine and Rehabilitation)
Builds
Clinical review processes and medical policies for DME utilization management
Domain
Healthcare / Insurance / Utilization Management
Required skills
Medical licensure, Board certification, Clinical experience, Utilization review, Peer-to-peer review, Policy interpretation, Program leadership
Preferred skills
Utilization management (UM), DME experience, Physical Medicine and Rehabilitation board certification
Technologies
Medicaid systems, Clinical review platforms
Responsibilities
Conduct peer-to-peer clinical reviews with physicians to discuss review determinations; Interpret medical policies and clinical guidelines; Develop and propose new medical policies based on healthcare changes; Lead clinical and non-clinical activities impacting healthcare quality and cost; Serve as a resource and consultant for other company areas.
Seniority
Director, strategic leadership with hands-on clinical review