Pay Growth
?
out of 5
Not enough data
Not enough info to score pay or growth
Medical Director
Job
at CAI in Montpelier, Vermont, United States
Montpelier, VT (In Person)
Full-Time
Review key factors to help you decide if the role fits your goals.
Job Security
?
out of 5
Not enough data
Calculating job security score...
Total Score
82
out of 100
Average of individual scores
Skill Insights
Compare your current skills to what this opportunity needs—we'll show you what you already have and what could strengthen your application.
Job Description
at CAI in Montpelier, Vermont, United States Job Description 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