Group Health Medical Director

🕒 May 5

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Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

📋 Compliance

🏛️ Government

Healthcare Insurance • Compliance • Government

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Perform utilization review for: • - Preauthorization requests • - Appeals (first and second level) • - Independent external reviews • - DRG validation and clinical review • - Benefit and coverage determinations • - Experimental/Investigational (E/I) review • Apply evidence-based criteria and guidelines, including: • - InterQual • - MCG • - CMS guidelines (including 2-Midnight Rule) • - LCD/NCD • - Client-specific policies • Produce clear, concise, and defensible clinical rationales • Maintain high accuracy and consistency across determinations • Meet or exceed turnaround time (TAT) expectations, including urgent cases • Participate in peer-to-peer discussions as needed • Collaborate with QA and operational teams to ensure quality and compliance • Reviews may be conducted within internal systems or client-specific platforms, depending on assignment and client requirements

🎯 Requirements

• MD or DO, board-certified in Internal Medicine, Family Medicine, or similar • Active, unrestricted medical license • Prior utilization review experience, preferably in a health plan or IRO environment • Familiarity with InterQual, MCG, and CMS guidelines • Strong clinical judgment and documentation skills • Ability to work independently in a high-throughput environment

🏖️ Benefits

• Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.