Career Connect

What you will be doing:

The Medical Director is responsible for processing Utilization Management (UM) requests that do not meet guidelines, processing appeals, education of the ordering providers in peer-to-peer calls. 

This is a fully remote position.

Key Responsibilities

Responsible for processing UM requests, appeals, and reconsiderations. Required to write a denial rationale in compliance with health plan and government agencies.
Required to be compliant with contractual obligations to the health plans and government agencies, and certifications that are maintained by Care to Care.
Required to participate in quarterly UM meetings
Responsible for identifying educational needs and participating in ongoing education and support for the medical and intake staff.
Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the Chief Medical Officer
Responsible for communicating need for additional clinical information to referring/prescribing providers related to consideration for authorization or modification of a referring provider’s request for radiological or diagnostic imaging services.
Required to collaborate with management to create and implement new process or quality improvement initiatives
Responsible for coordinating with UM Intake Specialists to ensure timely and accurate communication of clinical decisions
Required to collaborate with clinical team to review and update clinical criteria guidelines at least annually.

Required Certifications/Licensing 

• Current, unrestricted medical license in required specialty NY, NM, and/or CA medical license is preferred
• Board certified in required specialty (Radiology specialty required)

Required Qualifications

• MD: Medicine (Required)
• Candidates should be comfortable working 12:00 - 8:00 pm EST Monday - Friday

About Premier, Inc.

Premier, Inc. (NASDAQ: PINC) is a leading healthcare improvement company, uniting an alliance of more than 4,350 U.S. hospitals and health systems and approximately 300,000 other providers to transform healthcare. With integrated data and analytics, collaboratives, supply chain solutions, consulting and other services, Premier enables better care and outcomes at a lower cost. Premier plays a critical role in the rapidly evolving healthcare industry, collaborating with members to co-develop long-term innovations that reinvent and improve the way care is delivered to patients nationwide. Headquartered in Charlotte, N.C., Premier is passionate about transforming American healthcare. Please visit Premier’s news and investor sites on www.premierinc.com; as well as Twitter, Facebook, LinkedIn, YouTube, Instagram and Premier’s blog for more information about the company.

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