Back to Jobs search

Medical Director

CAI • Providence, RI • 13h ago

Medical Director

Req number:

R7707

Employment @type:

Full time

Worksite flexibility:

Remote

Who we are

CAI is a global services firm with over 9,000 associates worldwide and a yearly revenue of $1.3 billion+. We have over 40 years of excellence in uniting talent and technology to power the possible for our clients, colleagues, and communities. As a privately held company, we have the freedom and focus to do what is right-whatever it takes. Our tailor-made solutions create lasting results across the public and commercial sectors, and we are trailblazers in bringing neurodiversity to the enterprise.

Job Summary

We are looking for a motivated Medical Director ready to take us to the next level! If you have clinical expertise and strong decision-making skills and are looking for your next career move, apply now.

Job Description

We are looking for a Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most current clinical standards. This position will be Full-Time and Remote .

Due to our end client, candidates must be able to work on CAI's W2 without a need for sponsorship now or in the future.

What You'll Do

Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer-to-peer discussions, to determine medical necessity and appropriateness

Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned

Compose clear and concise rationales for members and provider determination notifications while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.)

Ensure that all aspects of the medical management process are consistent with community standards of care

Participate as a member of the CMDM multidisciplinary team: attend huddles and grand rounds, and advise the multidisciplinary team on cases requiring physician expertise

Participate in protocol and guidelines development to ensure consistency in the review process

Actively manage projects and/or participate on project teams that require a physician subject matter expert

What You'll Need

Required:

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)

Awarded Board Certification at least once in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards

Active medical state licensure required for PA, NY, or WV

5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)

Strong skills inCritical Thinking,Case Management,Customer Service,Oral & Written Communication,Collaboration,Listening,Telephone Skills,General Computer Skills,Clinical Software, andManaged Care

Preferred:

Master's Degree in Business Administration/Management or Public Health

1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry

Experience with MCG or InterQual

Physical Demands

Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state, and local standards

Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor

Must be able to communicate with customers/team members over the phone and in person

Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc

LI-AL2

Reasonable accommodation statement

If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employment selection process, please direct your inquiries to application.accommodations@cai.io or (888) 824 - 8111.

$170.00-$175.00 per hour

The pay range for this position is listed above. Exact compensation may vary based on several factors, including location, experience, and education. Benefit packages include medical, dental, and vision insurance, as well as 401k retirement account access. Employees in this role may also be entitled to paid sick leave and/or other paid time off as provided by applicable law.

CAI

Go to Apply

Share this job

Similar Jobs

Health Information Specialist I

Datavant • Providence, RI • 8h ago

Hospital & Medical

Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world's health data secure, accessible and actionable, we provide critical data solutions for organizations across the...

8h ago

Go to Apply

Director, State Public Policy for Pharmacy and Pharmacy Benefit Management

Humana • Providence, RI • 15h ago

Hospital & Medical

Become a part of our caring community The Director, State Public Policy, within Humana's Government Affairs team, is responsible for shaping and executing state-level policy strategy, with a primary focus on pharmacy-rel...

15h ago

Go to Apply

Registered Nurse II

State of Massachusetts • Fall River, MA • 15h ago

Hospital & Medical

The Dr. John C. Corrigan Mental Health Center is seeking dedicated and compassionate individuals for the position of a Registered Nurse II who desires a rewarding career making a difference in the lives of individuals. O...

15h ago

Go to Apply

Addiction and Mental Health Clinician (Human Services Coordinator II) - Recovery from Addictions Program

State of Massachusetts • Taunton, MA • 15h ago

Hospital & Medical

The Recovery from Addictions Program (RAP), operated by the Department of Mental Health (DMH), is seeking self-motivated individuals to provide direct care to clients, including, but not limited to individual counseling,...

15h ago

Go to Apply

Global Clinical Operations Manager

GE Aerospace • Providence, RI • 17h ago

Hospital & Medical

Job Description Summary The Global Clinical Operations Manager provides international clinical leadership and operational oversight for occupational health services across multiple aerospace facilities. This role is acco...

17h ago

Go to Apply

Bench Sales Manager - South Coast Area, MA - Lafrance Hospitality

Lafrance Hospitality • Westport, MA • 2d ago

Hospital & Medical

Are you a dynamic hospitality sales professional who thrives in a fast-paced environment and enjoys variety in your day-to-day work? Lafrance Hospitality is seeking an energetic and motivated Bench Sales Manager to suppo...

2d ago

Go to Apply

Weekend Home Health Physical Therapist

BAYADA Home Health Care • Milford, MA • 2d ago

Hospital & Medical

$5,000.00 SIGN-ON BONUS!!! Weekend Physical Therapist - Home Health Flexible Per Diem, Part-Time or Full-Time Schedule Premium Pay and Benefits!! BAYADA Home Health Care is currently seeking an experienced Weekend Physic...

2d ago

Go to Apply

Psychology Supervisor (Psychologist V)

State of Massachusetts • Taunton, MA • 2d ago

Hospital & Medical

Taunton State Hospital, operated by the Department of Mental Health, is seeking a qualified and dynamic individual to join our team as a Psychologist V. In this full-time role, you will function as the Psychology Supervi...

2d ago

Go to Apply

Residential Mental Health Worker I - Walpole

State of Massachusetts • Walpole, MA • 2d ago

Hospital & Medical

The Department of Mental Health Community Transition Program is seeking a conscientious individual to fill the role of Mental Health Worker I, within a residential program in Walpole, MA. Please note: This is a full time...

2d ago

Go to Apply

Medical Lab Scientist/Technician, Lead - SJH

Charter Care Health Partners • North Providence, RI • 2d ago

Hospital & Medical

Summary: Under the general direction of the Manager, Laboratory Services is responsible for the delivery of quality, cost-effective laboratory services at CharterCARE Health Partners in compliance with all regulatory and...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)