Job Description

BTG in partnership with the top ranked Health Insurance company in FL is seeking a Care Management Medical Director.

Medical Director Care Management

Job duties include but are not limited to: 
  • Perform all types of UM reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals 
  • Discuss cases with physician providers (Peer to Peer) 
  • Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on medical necessity requests 
  • Collaborate with Case Managers to provide support and guidance on cases needing physician assistance 
  • Meet any established metrics (compliance and accreditation) related to UM review efficiency, timeliness, and quality of review 
  • Participate in ongoing Inter-rater reliability (IRR) audits and any other health plan audits as necessary 
  • As necessary, assist nurses and other staff in understanding the principles behind appropriate utilization review and interpretation and application of benefits and policies 
  • Participate in the development and review of Medical and Pharmacy policies as assigned 
  • Support the organization as a subject matter expert 
  • Perform as lead Medical Director consultant for one sub-category of utilization management, such as commercial or Medicare medical policy 
  • Perform other duties as assigned and needed by the organization 
Job Requirements: 
  • Current unrestricted Florida medical license as a Doctor of Medicine or Doctor of Osteopathic Medicine or ability to obtain Florida Medical License 
  • Board eligible - American Board of Medical Specialties 
  • 3+ years of clinical experience 
  • Experience working in a dynamic, fast-paced environment 
  • Experience working both independently and in a team environment 
  • Exceptional verbal and written communication 
Preferred: 
  • Physician reviewer or utilization management experience 
  • Primary Care Specialty physician experience 

We are an Equal Opportunity Employer/Protected Veteran/Disabled.

If you believe that your skills and experience are a match for this position, please give us a call at 904-998-9414 to speak to a Recruiter, e-mail your most current resume to apply@btginc.com or apply on line at https://jobs.btginc.com
 

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online