Medical Director – Care Management

Job not on LinkedIn

🕒 February 14

🐊 Florida – Remote

🐊 Florida – Remote

💵 $224k - $364k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🏛️ Government

🏢 Enterprise

Healthcare Insurance • Government • Enterprise

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• Perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals • Discuss cases with physician providers (Peer to Peer) • Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on medical necessity requests • Collaborate with Case Managers to provide support and guidance on cases needing physician assistance • Meet any established metrics (compliance and accreditation) related to UM review efficiency, timeliness, and quality of review • Participate in ongoing Inter-rater reliability (IRR) audits and any other health plan audits as necessary • As necessary, assist nurses and other staff in understanding the principles behind appropriate utilization review and interpretation and application of benefits and policies • Participate in the development and review of Medical and Pharmacy policies as assigned • Support the organization as a subject matter expert • Perform as lead Medical Director consultant for one sub-category of utilization management, such as commercial or Medicare medical policy • Perform other duties as assigned and needed by the organization

🎯 Requirements

• Current unrestricted Florida medical license as a Doctor of Medicine or Doctor of Osteopathic Medicine • Board Certification or Board eligibility by American Board of Medical Specialties or equivalent • 5+ years of clinical experience • Experience working in a dynamic, fast-paced environment • Experience working both independently and in a team environment • Exceptional verbal and written communication • Physician reviewer or utilization management experience (Preferred) • Primary Care Specialty physician experience (Preferred)

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance; • Income protection benefits: life insurance, short- and long-term disability programs; • Leave programs to support personal circumstances; • Retirement Savings Plan including employer match; • Paid time off, volunteer time off, 10 holidays and 2 well-being days; • Additional voluntary benefits available; • A comprehensive wellness program