UM Medical Director - Medical Genetics and Genomics - Remote

Primary Responsibilities

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations
• Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements
• Engage with requesting providers as needed in peer-to-peer discussions
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
• Participate in daily clinical rounds as requested
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
• Communicate and collaborate with other internal partners
• Call coverage rotation

Required Qualifications

• M.D. or D.O.
• Active unrestricted license to practice medicine
• Board certified Medical Genetics and Genomics OR Board certified in Family Medicine or Internal Medicine with training in genetics (Board certifications must be through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA))
• 5+ years of clinical practice experience after completing residency training
• Proven sound understanding of Evidence Based Medicine (EBM)
• PC skills, specifically using MS Word, Outlook, and Excel
• Participate in rotational holiday and call coverage

Preferred Qualifications

• Licensed in MA or MN
• Utilization Management or clinical coverage review experience for an insurance or managed care organization
• 2+ years of Hospitalist Experience
• Experience doing reviews and Utilization Management for inpatient stays
• Innovative problem-solving skills
• Proven presentation skills for both clinical and non-clinical audiences
• Demonstrated excellent oral, written, and interpersonal communication skills, facilitation skills

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

Pay

The salary for this role will range from $248,500 - $373,000 annually based on full-time employment.

Schedule

Candidates are required to pass a drug test before beginning employment.