Director of Medical Services

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Title: Director of Medical Services Duration: 6 Months with potential for extension or full-time conversion We are seeking a board-certified physician to lead our Medicare Inpatient Pod. In this vital role, you will collaborate closely with the Chief Medical Director to oversee utilization management, quality enhancement, credentialing, and appeals associated with high-volume inpatient and post-acute care reviews. You will play a crucial role in making determinations regarding medical necessity using InterQual/MCG, supporting effective discharge planning, mentoring provider relationships, and contributing to efforts aimed at reducing readmissions while adhering to productivity and audit benchmarks. Base pay range $110.00/hr - $130.00/hr Key Responsibilities Provide strategic medical leadership for utilization management, cost-containment, and quality improvement initiatives. Conduct concurrent inpatient and post-acute reviews as well as review complex and controversial services and claims appeals. Support physician committee functions and drive performance improvement initiatives. Engage with high-risk members during rounds and collaborate effectively with care management teams. Develop educational resources for physicians and enhance provider relationships; represent the business unit as needed. Consult on Substance Use Disorder (SUD) policy and Managed Care Member (MCM) cases when required. Qualifications Active board certification in Internal Medicine or Family Medicine. Possession of active, unrestricted medical licenses in FL and TX. Hands-on experience with InterQual and/or MCG methodologies. Inpatient clinical experience or previous physician advisor roles. Preferred Qualifications Additional multi-state licenses (MI, MS, NJ, NC, CA, KS, AR) are a plus. Performance Expectations Productivity target of approximately 45+ cases per day. Job Function and Seniority Job function: Management and Health Care Provider Industries: Hospitals, Health Care, and Insurance
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Location:
Seattle, WA, United States
Job Type:
FullTime
Category:
Healthcare Practitioners And Technical Occupations

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