Medical Director
Not Disclosed•Full-TimeRemote
location_on1124, Bratton Street, Jackson, Hinds County, Mississippi, 39203, United States
Who We Are
CAI is a global services firm with over 9,000 associates worldwide and a yearly revenue of $1.3 billion+. For over 40 years, we have united 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.
About the Role
We are seeking a motivated Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most current clinical standards. This Full-Time, Remote position is designed for a clinician ready to take our medical management capabilities to the next level. You will serve as a key member of the CMDM multidisciplinary team, advising on complex cases requiring physician expertise and participating in the development of protocols and guidelines to ensure consistency in the review process.
Hiring Process & Application Instructions
Due to our end client requirements, candidates must be able to work on CAI's W2 without a need for sponsorship now or in the future. 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.
Equal Opportunity
CAI is an equal opportunity employer committed to diversity and inclusion. We are trailblazers in bringing neurodiversity to the enterprise and consider qualified applicants regardless of background.
Work location
Work model: Remote
1124, Bratton Street, Jackson, Hinds County, Mississippi, 39203, United States
Jackson, Mississippi
Key Responsibilities
- check_circleConduct electronic review of escalated cases against medical policy criteria to determine medical necessity
- check_circleCompose clear rationales for member and provider notifications while adhering to compliance standards
- check_circleParticipate in multidisciplinary team activities and advise on cases requiring physician expertise
- check_circleParticipate in protocol and guidelines development to ensure consistency in the review process
- check_circleActively manage projects or serve as a physician subject matter expert on project teams
- check_circleComplete initial case determinations, review appeals and grievances, and perform other assigned reviews
- check_circleEnsure medical management processes remain consistent with community standards of care
Requirements
- verifiedMedical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
- verifiedBoard Certification in a specialty recognized by ABMS or AOA
- verifiedActive medical state licensure in PA, NY, or WV
- verified5 years in Clinical, Direct Patient care
- verifiedAbility to work on CAI's W2 without sponsorship
- verifiedStrong skills in Critical Thinking, Case Management, Customer Service, Oral & Written Communication, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software, and Managed Care
- verifiedMaster's Degree in Business Administration/Management or Public Health (Preferred)
- verified1 year in Medical Management in a Health Insurance Plan (Preferred)
- verifiedExperience with MCG or InterQual (Preferred)
Nice to Have
Master's Degree in Business Administration/Management or Public Health. 1 year in Medical Management in a Health Insurance Plan with strong knowledge of the managed care industry. Experience with MCG or InterQual.
Benefits & Perks
check_circleMedical, dental, and vision insurancecheck_circle401k retirement account accesscheck_circlePaid sick leave and/or other paid time off as provided by applicable law
Similar Job Opportunities
Skills, education and keywords
Skills: Critical Thinking, Case Management, Customer Service, Oral Communication, Written Communication, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software.
Education: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required; Master's Degree in Business Administration/Management or Public Health preferred.
Frequently asked questions about Medical Director at CAI
What does a Medical Director at CAI do?expand_more
Day-to-day, the Medical Director at CAI will conduct electronic review of escalated cases against medical policy criteria to determine medical necessity; compose clear rationales for member and provider notifications while adhering to compliance standards; participate in multidisciplinary team activities and advise on cases requiring physician expertise; and participate in protocol and guidelines development to ensure consistency in the review process.
What are the requirements for this Medical Director role?expand_more
To qualify for the Medical Director at CAI position, applicants should have: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO); Board Certification in a specialty recognized by ABMS or AOA; Active medical state licensure in PA, NY, or WV; 5 years in Clinical, Direct Patient care; Ability to work on CAI's W2 without sponsorship; and Strong skills in Critical Thinking, Case Management, Customer Service, Oral & Written Communication, Collaboration, Listening, Telephone Skills, General Computer Skills, Clinical Software, and Managed Care.
Where is the Medical Director role at CAI located?expand_more
Medical Director at CAI is based in 1124, Bratton Street, Jackson, Hinds County, Mississippi, 39203, United States. This is a remote role.
Is this Medical Director job remote, hybrid, or on-site?expand_more
CAI has listed this Medical Director role as remote.
How much experience is required for this Medical Director role?expand_more
Medical Director at CAI typically requires 5+ years of relevant experience at the executive level.
What skills do you need for the Medical Director role at CAI?expand_more
Key skills for Medical Director at CAI include Critical Thinking; Case Management; Customer Service; Oral Communication; Written Communication; Collaboration; Listening; and Telephone Skills.
What education is required for Medical Director at CAI?expand_more
Educational requirements for this role: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required; and Master's Degree in Business Administration/Management or Public Health preferred.
What category does the Medical Director role belong to?expand_more
Medical Director at CAI is part of the healthcare & nursing job category on Recrutus.