Career Opportunities at Provider Resources, Inc. (PRI)
Position Description: Medical Director
Reporting to the Provider Resources, Inc (PRI) Chief Medical Director, the Medical Director will provide leadership of the medical review program and staff of PRI. The Medical Director will provide counsel, advice and strategic direction incorporating a clinical point of view. S/he, in conjunction with the Medical Review Nurse Manager, will be responsible for overseeing all aspects of the medical review process and maintaining maximum quality throughout all medical review activities.
Responsibilities
- Understand and represent PRI’s mission, vision, and values to all internal and external customers
- Engage clients in appropriate communication that manages client expectations and builds a collaborative relationship with the client
- Interact with government and private sector clients, partners, and PRI staff in a professional and accountable manner, and as a representative of PRI management
- Contribute to business development efforts for new sales and marketing to promote the business, including responses to requests for quotes, sources sought, proposals, and/or presentations as
- Perform clinical reviews for medical necessity, interpretation of code set application, adherence to regulation and any other client directive
- Recruit, coordinate, direct and interface with consultant physician reviewers
- Present data analysis and interpretations related to clinical matters
- Oversee the nurse medical review processes to ensure compliance with federal and other regulations
- Engage and develop educational programs for staff and clients as required to ensure quality outcomes
- Perform other duties as requested
Requirements:
- Medical degree (M.D. or D.O.) from an accredited institution with an active license is required
- Board Certification in a specialty recognized by the American Board of Medical Specialties required
- Post-graduate education in Health Care Administration, Public Health or an M.B.A., or the equivalent experience is preferred
- Five or more years experience in health care administration or medical staff leadership role
- Experience in utilization management, quality management and clinical policy and protocol development preferred
- Must have no adverse actions pending or taken against him/her by any State or Federal licensing board or program
- Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
- Must have and maintain a valid driver’s license issued by the state of residence
- Must submit to background checks and drug testing as applicable to client requirements
- Knowledgeable of ICD-9-CM, CPT-4 and HCPCS coding
- Knowledge of Microsoft office suite such as Outlook, Access, Excel and Word
- Knowledge of Interqual and Milliman guidelines
- Knowledge of policy development and application of evidenced based medicine
- Must have no conflict of interest (COI) as defined in 1154(b)(1) of the Social Security Act (SSA)
- Ability to obtain and maintain U.S. Government Security Clearance
Resume, cover letter, and salary requirements can be sent to HR@Provider-Resources.com