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Associate Medical Director, Post Acute Care (100% Remote)
Bloomfield, Connecticut, United States

Job Summary

Occupation Physician
Specialty Internal Medicine
Degree Required MD/DO
Position Type Permanent/Full-Time
Work Environment Clinic/Private Practice
Location Melbourne, Florida, United States
Visa Sponsorship No

Job Description

Last Update: 12/10/18

Responsibilities:

  • Perform the full range of post-acute program medical necessity reviews utilizing nationally accepted medical necessity criteria for Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Long Term Acute Care Facility (LTAC) for admissions, length of stay appropriateness and Durable Medical Equipment (DME).
  • Utilize CMS guidelines, NCDs, LCDs, and appropriate guidelines (InterQual, Milliman and Robbins) in medical necessity determinations.
  • Available for Peer to Peer consultations.
  • Available to attending physicians and/or ordering providers to conduct peer to peer discussions concerning utilization management issues.
  • Serve as an advisor on other clinical matters within area(s) of expertise.
  • Support the Clinical Services Staff as needed.
  • Participate in calls and meetings with clients as needed.
  • Participate in special projects as needed.
  • Assist in the Guidelines/Criteria updates as needed.
  • Perform other duties as required by the Chief Medical Officer of Post-Acute Care.

Minimum Requirements:

    • Board Certification from an approved, pertinent ABMS Board with a current, valid and unrestricted license in the United States.
    • Internal Medicine, Family Practice with or without subspecialty preferred, Physical Medicine and Rehabilitation Preferred
    • Knowledge of applicable state and federal laws, URAC and NCQA standards.
    • At least 5 years of experience in direct patient care.
    • Medical Management Experience is desired.
    • Managed Care Experience is desired.
    • Communication and presentation skills strongly preferred.