Job Description
* REMOTE & WEEKENDS ONLY **
Summary:
The Associate Medical Director provides support for Community Health Choice medical management programs. This includes performing medical necessity reviews, with peer-to-peer interactions as needed; appeals of adverse determinations.
Responsibilities:
The Associate Medical Director provides support for Community Health Choice medical management programs.
This includes performing medical necessity reviews, with peer-to-peer interactions as needed.
Appeals of adverse determinations.
Qualifications:
M.D. or D.O. Degree and Licensure in the State of Texas, Completion of Residency and Board Certification with preference for the Primary Care Specialties
Two (2) years prior managed care experience, to include proficiency in performing medical necessity reviews, benefit coverage reviews, and reviews of appeals of adverse determinations; Experience with STAR, CHIP and Health Insurance Marketplace programs preferred; Three (3)years clinical experience
Software Operated: Microsoft Office (Word, Excel, Outlook)
Preferred Skills:
Communication Skills: Above Average Verbal (Heavy Public Contact) Exceptional Verbal (e.g., Public Speaking) Writing /Composing: Correspondence/Reports
Other Skills: Analytical/Medical Terminology
Advanced Education: Doctorate Major: M.D. or D.O.
Work Schedule: Flexible
Pay range and compensation package - $84-$112 HOURLY
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