Field Medical Director, Vascular Surgeon

What You’ll Be Doing

• Serve as the specialty match reviewer in Vascular cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
• Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
• Provides clinical rationale for standard and expedited appeals.
• Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU’s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
• Aids and acts as a resource to Initial Clinical Reviewers.
• Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• Participates in on-going training per inter-rater reliability process.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
• On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.

Qualifications

• MD/DO/MBBS - Required
• Minimum of five (5) years’ experience in the practice of Vascular Surgeon - Preferred
• Current, unrestricted clinical license in medicine or required specialty - Required
• Obtaining and maintaining medical licenses in the state you reside - Required
• Active Board Certification in Vascular Surgery or Active Board Certification in General Surgery with extensive experience in Vascular Surgery - Required
• Strong clinical, management, communication, and organizational skills - Required
• Energetic and curious with a passion for quality and value in health care - Required
• Computer Proficiency - Required

Technical Requirements

• High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.