Associate Medical Director -- Physician Reviewer
- On site resource for the staff for medical review;
- Duties may include but not limited to: adjudication of appeals, clinical panel medical review, research, development, and training for the medical review staff.
- Functions as liaison to the medical consultant panel.
- Researches controversial medical procedures or technology.
- Clarifies coding and medical necessity issues.
- Maintains familiarity with Medicare regulations as required by position.
- Provides recommendations to facilitate operational efficiencies.
- Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree; active and unrestricted license in the United States.
- Board Certification in American Board of Medical Specialties (ABMS) recognized specialty.
- Geriatric Medicine, Physiatry, Internal Medicine or Family Medicine strongly preferred.
- Broad clinical experience of minimum of 5 years to include experience with inpatient care settings such as Skilled Nursing Facilities, Acute Inpatient Care, Acute Inpatient Rehabilitation and/or Long Term Acute Care.
- Knowledge of medical review and utilization review.
- Preferred two years experience with Medicare rules & regulations with a demonstrated understanding of the Medicare program.
- Preferred two years experience in medical data analysis and analytical capability to interpret statistical information.
- Experience serving on medical staff committees, quality improvement activities, credentialing activities, etc, preferred.
- Experience in education and training preferred.
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