Utilization Review Medical Director

October 9

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Medical Review Institute of America, LLC

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Healthcare Insurance • SaaS • Data

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

📋 Description

• Conduct coverage reviews using critical thinking and clinical expertise, based on individual patient/member benefits and national or proprietary coverage review policies. • Interpret benefit language and policies to guide clinical coverage determinations. • Document clinical review findings and outcomes in compliance with organizational, regulatory, and accreditation standards. • Engage in peer-to-peer consultations with prescribing providers when appropriate. • Collaborate and communicate effectively with fellow Medical Directors.

🎯 Requirements

• Hold active state licensure as a Medical Doctor (MD/DO), any state. • Hold current board certification in either Family Medicine or Internal Medicine (no other specialty board certification is currently needed). • Possess a minimum of 5 years of direct patient care experience post training, with the most recent experience no less than 6 months ago (recent clinical care is essential). • Have recently (within the past 2 years) work in an inpatient/hospital setting. • Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them). • Have a clean background, without prior licensure issues, pending/prior malpractice cases or legal issues. • Possess excellent verbal and written communication skills. • Excellent interpretation skills, divergent/creative thinking skills. • Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.

🏖️ Benefits

• Healthcare, vision, and dental insurance • 401(k) retirement plan with generous company match • 33 days of paid time off per year • Additional employee benefits