Express Scripts
Job Description:
Working at eviCore allows you to make a difference in people’s lives by improving the quality of their healthcare. As an Associate Medical Director, you will feel intellectually stimulated and challenged, and you will be empowered by the difference you are making on a more global level in healthcare.
Job Responsibilities:
- Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
- Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
- Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
- Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
- Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
- Participates in strategic planning for and evaluation of the Care Management process/unit.
Job Requirements:
- The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Radiation Oncology, recognized by the American Board of Medical Specialties (ABMS), or American Osteopathic Association (AOA)
- Recent practice experience in direct patient care (within the past 18 months).
- Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required
- Must have a minimum of 5 years clinical experience, beyond residency/fellowship
- This position is not eligible to be performed in Colorado.
Job Details:
Company: Express Scripts
Vacancy Type: Full Time
Job Location: Melbourne, FL, US
Application Deadline: N/A
