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Doctorate of Medicine Required
One (1) year in a clinical practice experience Required
The Medical Director- Medical Management Department serves as a clinical resource to Innovation Care Partners prior authorization and utilization review team. This role works closely with the ICP providers to include: medical necessity case reviews, clinical compliance, continued stay review, quality issue or trend idenitfication, and case management.
- Conducts clinical review on cases referred by prior authorization/utilization review staff ensuring quality patient care and effective, efficient utilization of healthcare services, evidence-based practice, and to meet regulatory requirements. Reviews will be conducted in MCG software and conducted with in regulatory timeframes.
- Meets with medical management team as needed to discuss selected cases and make case recommendations. Interacts with ICP providers and medical directors of payers to discuss the patient needs and alternative levels of care.
- Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, evidence-based guidelines, and use of resources.
- Acts as consultant and resource to the medical staff regarding federal and state utilization and quality regulations.
- Attend quarterly Medical Management Committee meetings with payors.
- Assist in covering TCM high risk rounds as needed.
- Performs other duties as assigned.