Back to Jobs search

Medical Director

CAI • Montpelier, VT • 2d ago

Medical Director

Req number:

R8076

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 experience in utilization management, 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 .

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 in Critical Thinking, Case Management, Customer Service, Oral & Written Communication, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software, and Managed 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

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.

EEO Statement

It is the policy of Computer Aid, Inc.(CAI) not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of CAI to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Employees and applicants of CAI will not be subject to harassment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. Additionally, retaliation, including intimidation, threats, or coercion, because an employee or applicant has objected to discrimination, engaged or may engage in filing a complaint, assisted in a review, investigation, or hearing or have otherwise sought to obtain their legal rights under any Federal, State, or local EEO law is prohibited.

$160-$170 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

CVMC Occupational Therapist

University of Vermont Health • Berlin, VT • 1d ago

Hospital & Medical

CVMC Occupational Therapist Job Details Job Ref: R0088547 Category: Rehabilitation Service/Therapy Employment Type: Part-Time Health Care Partner: Central Vermont Medical Center Location: 1311 Barre Montpelier Rd, Berlin...

1d ago

Go to Apply

Director of Nursing-Woodridge

University of Vermont Health • Berlin, VT • 2d ago

Hospital & Medical

Director of Nursing-Woodridge Job Details Job Ref: R0088612 Category: Leadership Employment Type: Full-Time Health Care Partner: Central Vermont Medical Center Location: 142 Woodridge Dr, Berlin, VT Department: CVMC - Wo...

2d ago

Go to Apply

Cardiovascular Disease Senior Specialist - United States

Merck • Montpelier, VT • 2d ago

Hospital & Medical

Job Description Job Description: As a Cardiovascular Disease Senior Specialist, you will drive meaningful patient impact by leveraging our scientific expertise and serving as the primary contact for customers within your...

2d ago

Go to Apply

Urgent Care Nurse Practitioner

Included Health • Vermont • 2d ago

Hospital & Medical

We're seeking board certified Nurse Practitioners licensed in Vermont (multi licensed strongly preferred) with broad clinical expertise and a passion for improving healthcare access and quality. In this role, you'll del...

2d ago

Go to Apply

Tri-State Region Professional Services Veterinarian-Companion Animal

Merck • Montpelier, VT • 3d ago

Hospital & Medical

Job Description This position will be field based within the Tri-State Region (NJ, NY, CT, RI) Our Company is driven by our unconditional commitment to the science of healthier animals. Our commitment is portrayed throug...

3d ago

Go to Apply

Healthcare Customer Service Collections Self Pay

Cognizant • Montpelier, VT • 4d ago

Hospital & Medical

Schedule: 8:15am 5:00pm EST and one day 11:15am-8:00pm EST M-F About the role As a Healthcare Customer Service Collections - Self-Pay you will make an impact by assisting our clients' customers with their outstanding bal...

4d ago

Go to Apply

Travel Registered Nurse (In-state Float Nurse) 3x12 Schedule

Wellpath • Waterbury, VT • 4d ago

Hospital & Medical

You Matter Make a difference every day in the lives of the underserved Join a mission driven organization with a people first culture Excellent career growth opportunities Join us and find a career that supports: Caring...

4d ago

Go to Apply

REMOTE -Principal Software Developer- Agentic AI, Healthcare AI

Oracle • Montpelier, VT • 1w ago

Hospital & Medical

Job Description Responsibilities Architect, design, develop, deploy, and operate production-grade AI systems powered by LLMs, agents, retrieval, and enterprise data. Build agentic AI systems that leverage tool use, memor...

1w ago

Go to Apply

AOT District Administrative & Technical Assistant IV

State of Vermont • Barre, VT • 1w ago

Hospital & Medical

This job was posted by https://www.vermontjoblink.com : For more information, please see: https://www.vermontjoblink.com/jobs/1393209 Overview The Agency of Transportation is seeking a District Administrative & Techn...

1w ago

Go to Apply

AOT Technician II - Bridge Inspection

State of Vermont • Barre, VT • 1w ago

Hospital & Medical

This job was posted by https://www.vermontjoblink.com : For more information, please see: https://www.vermontjoblink.com/jobs/1393472 Overview The Vermont Agency of Transportation (AOT) is seeking a motivated and detail-...

1w ago

Go to Apply

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