SVP Medical Director

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $250k - $275k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏢 Enterprise

📋 Compliance

Insurance • Enterprise • Compliance

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• To evaluate medical reports escalated due to deficient information utilizing evidence based criteria; • To provide leadership within the dedicated team of clinician and claim professionals. • Participate in client stewardship discussions, claim roundtables, and complex medical escalations. • Stay current on emerging medical trends, treatment standards, clinical literature, and evidence-based guidelines; • Support workers’ compensation, disability, FMLA, fitness-for-duty, return-to-work, liability, and safety-sensitive workforce issues. • Obtain and maintain Medical Director licensure in a few select states, as needed. • Apply applicable clinical guidelines and medical literature to support defensible recommendations, claim discussions, and treatment-plan clarification. • Engage treating providers when needed and support appeals, independent medical review considerations, peer review alignment, and clinical quality review. • Documenting recommendations within templates in Juris and SharePoint using the appropriate format referencing evidence-based criteria within the required time frame. • Developing and delivering training materials and presentations to meet training needs. • Interfacing and providing guidance and leadership to the Client dedicated leadership team as well as team leads.

🎯 Requirements

• Medical Doctor (M.D.) degree required. • Ten (10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. • Knowledge of evidence-based guidelines • Knowledge of ADAA and FMLA • Knowledge of utilization review procedures • Knowledge of clinical quality systems and measurements • Knowledge of resources available regarding regulations and parameters of third party reimbursement, benefit determinations and payments • Knowledge of statutory requirements of state's jurisdiction/ERISA regulations • Knowledge about general claim practices. • Knowledge of pharmacy processes and pharmacy benefit management a plus. • Understanding of pain management a plus. • Excellent oral and written communication skills, including presentation skills • PC literate, including Microsoft Office products • Analytical and interpretive skills • Strong organizational skills • Excellent interpersonal skills • Proven management/leadership skills • Ability to create and complete comprehensive, accurate and constructive written reports • Ability to work in a team environment.

🏖️ Benefits

• Three medical, and two dental & vision plans to choose from. • Tuition reimbursement • 401K plan that matches 50% on every $ you put in up to the first 6% you save. • 4 weeks PTO your first full year. • Reasonable accommodations when applicable and appropriate.