Assistant Medical Director

Description:
?? Provide benefit coverage determinations based on medical necessity and contract language
?? Support clinical review activities including pre-service, post-service, concurrent facility-based care
?? Act as the final decision maker for coverage decisions
?? Use clinical expertise to support claims review decisions
?? Support peer-to-peer discussion process with external physicians
?? Consult with nursing and other clinical staff to assess care options
?? Participate in the development and annual review of company medical review criteria
?? Leverage clinical knowledge and expertise to support ongoing education for clinicians
?? Provide professional advisement for consultation requests
?? Participate in Inter-Rater Review process for consistency in clinical decision making
?? Understand and abide by federal, state, and accreditation regulations
?? Complete all professional continuing education requirements

Requirements: ?? Physicians license with an MD or DO degree ?? Unrestricted Washington state licensure or administrative license or ability to obtain within 90 days ?? Five (5) years of clinical experience ?? Current board certification from the American Board of Medical Specialties, or the American Osteopathic Association or other recognized Association acceptable to Premera ?? Previous experience performing medical necessity and clinical reviews in a health plan setting (Preferred) ?? Prior use of clinical criteria sets and clinical pathways, such as MCG (Milliman Care Guidelines), Interqual?? or others (Preferred) ?? Familiarity with CPT, ICD, HCPC code sets and RBRVS pricing concepts (Preferred)

Benefits:
?? Medical, vision and dental coverage
?? Life and disability insurance
?? Retirement programs (401K employer match and pension plan)
?? Wellness incentives, onsite services, a discount program and more
?? Tuition assistance for undergraduate and graduate degrees
?? Generous Paid Time Off to reenergize
?? Free parking

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