Das ist der Job
Provide clinical rationale for standard and expedited appeals.
Darum lohnt es sich
Job Summary
As a Vascular Surgery, Field Medical Director, you will be a key member of the utilization management team, providing a meaningful way to make a difference in patients’ lives within a non-clinical environment.
You will enjoy better work‑life balance on a team that values collaboration and continuous learning while delivering improved health outcomes. Collaboration Opportunities Routinely interacts with leadership and management staff, other physicians, and staff whenever physician input is needed or required.
Responsibilities Serve as the specialty match reviewer for vascular cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Discuss determinations (peer‑to‑peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.
Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process, reflecting appropriate utilization and compliance with SBU’s policies/procedures, as well as URAC and NCQA guidelines. Aid and act as a resource to Initial Clinical Reviewers. Ensure documentation of all communications with medi
