Medical Director; Utilization Review – Part-Time (1882672) – IN0009639872

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Key Family of Companies (American Health Data Institute) is currently seeking a part-time Medical Director; Utilization Review at our Indianapolis, IN 46250 headquarters location.Responsibilities:Provide organizational leadership in the operational areas of utilization review, case management, quality improvement and related initiatives. Assists in the development and implementation of medical policy, including recommendations for modifications to enhance efficiency and effectiveness. Assures compliance with medical policy. Maintains compliance with all federal, state, and local regulatory guidelines. Directs the efforts of the utilization review, case management, and pre-certification functions to accomplish objectives within policy. Performs daily medical reviews.Serves as medical expert for care management; reviews and evaluates cases with UM nurses and UM coordinators.Manages medical review processes; reviews prior authorization requests and conducts reviews of claims and appeals.Participates in the functioning of the plan’s grievance and appeals processes.Ensures medical decisions are not influenced by fiscal or administrative considerations.In coordination with the Nurse Manager, implements and develops medical protocols, policies, and rules of conduct for nursing staff.Collaborates with other departments i.e. Claims to coordinate operations and programs; Client Services to respond to clinical related issues from clients; Sales and Marketing to assist with questions posed by clients and prospects.Other projects and duties as assigned.Possess the Ability To:Understand, communicate, and implement regulations, policies, and guidelines.Establish and maintain successful interpersonal relationships with all levels of staff, external constituents, and the public as appropriate.Communicate clearly and concisely, both verbally and in writing.Work under the pressure of strict deadlines on multiple projects in a fast-paced environment.Collaborate with and direct others depending upon the task or project in process.Education/Experience:Medical Degree5+ years full-time experience practicing medicine.Primary care discipline with emphasis in preventative and chronic condition care.Must be Board-certified in his/her medical specialty.The successful candidate will have Indiana licensure.Please note: Video resumes for the Medical Director; Utilization Review-Part-Time position will not be accepted at this time.If you are unable to complete an application due to a disability, contact Human Resources by calling 800-560-3539 to ask for an accommodation or an alternative application process.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran

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  • Health Care Provider

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