Part-Time Medical Director – Utilization Management

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October 22

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HealthAxis Group

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Healthcare Insurance • SaaS • Fintech

HealthAxis Group is a technology solutions provider specializing in healthcare administration. Their cloud-native platform, AxisCore™, streamlines health plan management through solutions like claims processing and benefit administration, designed to enhance operational efficiency. HealthAxis offers a suite of services including Business Process as a Service (BPaaS), consulting, and staff augmentation. The company's approach focuses on scalability, compliance, and tailored support, aiming to empower healthcare organizations to meet member needs effectively.

201 - 500 employees

Founded 1965

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

📋 Description

• Responsible for working hand-in-hand with senior leaders to provide medical expertise and decision making within the Utilization Management team. • Responsible for ensuring that healthcare services are medically necessary, appropriately utilized, and meet the highest standard of quality. • Adhere to standard Federal, State and/or CMS compliant medical policies within the organization. • Reviewing clinical cases, providing medical expertise, and collaborating with various stakeholders to ensure efficient and effective healthcare delivery. • Maintaining accurate and thorough documentation of activities and decisions. • Analyzes aggregate data and reports to primary care physician. • Serves as the liaison between physicians and health plan Medical Directors. • Participates in the Grievance and Appeal review process to provide recommendations. • Identify process improvements opportunities and inefficiencies.

🎯 Requirements

• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree. • Preferably, Board Certified Family Practitioner or Internal Medical Specialist. • Unrestricted licensed in at least one state within the United States. • 5+ years of clinical practice experience. • 2+ years of experience in utilization management activities. • Proficiency with Microsoft Office applications. • M.D or D.O and five (5) years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. • Board Certified in an American Board of Medical Specialties Board, and an active, unrestricted license to practice medicine in a state or territory of the United States. • Previous experience with administrative oversight of the medical function of an insurance (or related) company. • Previous experience leading a team of professionals. • A strong perspective on how to increase operational excellence and automation through process improvement and technology partnerships. • Strong interpersonal skills, with the ability to regularly interact with various client departments/project teams. • An ability to balance critical thinking with hands-on execution. Forward-thinking strategic leader. • Results-driven. Ability to work in a fast-paced and changing environment and react professionally under pressure. • Self-starter with strong organizational skills. Excellent oral and written communication skills.

🏖️ Benefits

• HealthAxis provides a people-first approach that values collaboration as a team to serve clients. • Opportunity to be involved in additional responsibilities such as special projects, focus groups, new Medical Director training, or organizational committees.