Medical Director - OneHome
Core
Review clinical cases and determine medical necessity of services for Medicare and Medicaid members, ensuring compliance with CMS, Medicare, and Medicaid requirements.
Role type
Senior clinical medical director (physician)
Builds
Clinical review decisions and operational improvements for home health and SNF services
Domain
US Healthcare / Medicare & Medicaid / Home Health
Required skills
Clinical case review, Medical necessity determination, CMS/Medicare/Medicaid policy interpretation, Regulatory compliance, Clinical guidelines application, Operational improvement identification, Call rotation management, Educational content creation
Preferred skills
Inpatient/outpatient experience, Geriatrics, Internal Medicine, Family Practice, Surgery, Critical Care
Technologies
Microsoft Office
Responsibilities
Review clinical cases for Medicare/Medicaid members, Ensure compliance with review policies and regulatory standards, Apply clinical guidelines and CMS policies, Identify opportunities for medical management operational improvements, Participate in call rotations including weekend and after-hours coverage, Contribute to team culture and deliver consumer experiences, Participate in educational activities and conferences
Seniority
Senior, hands-on IC