What are the responsibilities and job description for the Medical Director position at National Medical Association?
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Essential Job Functions and Responsibilities
Review medical treatment plans for complex claims referred by the managed care team, discuss claims management with treating physicians, and advise internal nurse case managers on appropriate actions.
Respond to questions submitted by managed care
Review external clinical guidelines and review and update internal guidelines and policies to meet specific objectives and improve claim outcomes.
Ensure medical accuracy and quality by reviewing samples of peer reviews and independent medical exams. Comply with other internal Quality Assurance activities as required by URAC and other accrediting bodies.
Provide oversight / review of clinical content for internal training programs. Facilitate and participate in new hire and on-going training of clinical personnel (MDs, RNs) when required.
Explore and disseminate significant updates / changes in internal medical policies to claims managers and the managed care team. Evaluate decision support tools such as treatment guidelines and protocols to support Claims.
Participate in and provide medical advice to internal steering committees with various missions as well as task forces relating to specific issues / problems.
Serve as a medical resource for a variety of activities, including Legal, Loss Prevention, and Business Development.
May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
Performs other duties as assigned.
This position allows for a hybrid work environment as well as FT remote.
Education : Board certified, licensed, practicing physician (MD or DO).
Field of Study : Medicine.
Experience : Generally, 5 or more years of clinical practice experience. Experience with workplace issues, short- and long-term disability, and workers compensation. Expertise with occupational and orthopedic illness / injuries.
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