Medical Director

POSITION DUTIES & RESPONSIBILITIES

• Clinical review of cases for Prior Authorizations
• Clinical review cases for Concurrent Reviews
• Retrospective Reviews
• Apply clinical practice guidelines and conduct medical necessity determinations
• Collaborate with case management and care coordination teams
• Contribute clinical insight to population health efforts and care pathways
• Conduct drug utilization reviews and evaluate new medical technologies
• Assess the clinical benefit of emerging technologies or procedures
• Support transplant case oversight
• Analyze data for clinical and operational improvement
• Ensure timely review and documentation aligned with regulatory requirements
• Participate in special projects and quality improvement initiatives

EDUCATION, TRAINING AND EXPERIENCE

• Current Arizona license to practice medicine without restrictions
• Medical Doctorate or Doctor of Osteopathy degree required with appropriate Board Certification or qualification and level of expertise typically gained through 5 years’ experience in clinical practice
• 3 to 5 years of medical administrative experience, preferably with emphasis on managed care members and Medicare rules and regulations
• Experience in developing utilization protocols and supporting and motivating the clerical and nursing staff
• Confidence in medical decision-making and strong peer communication skills
• Strong/creative UM experience and realistic approach to case management
• Ability to research and integrate payor requirements into AZPC processes
• Ability to interact with all levels of management, physicians, staff, health plan representatives, and outside agencies/vendors
• Possess excellent communication, organizational, and influencing skills
• Knowledge of computers and experience using MS Office Programs (i.e., Word, Excel, Outlook, and PowerPoint)

COMPENSATION

The salary range for this position is: $225,000 – $275,000.