Top Healthcare company is hiring a Physical Health Medical Director to work remotely in North Carolina.
The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination.
This position will allow the successful candidate to work primarily remote.
While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate.
This position may be required to work weekends and holidays based on organizational and operational requirements.
Responsibilities & Duties
Clinical Oversight & Medical Review
Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care
Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services
Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards
Review Approval and Denial of Service and Level of Care Requests
Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department
Process Adherence, Quality & Efficiency
Follow department processes-as defined by approved policies, desk procedures, and workflows referenced on the Company Grid and in the Medical Director OneNote-to complete timely utilization reviews in UM platform and perform tasks efficiently
Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance
Operational & Committee Support
Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee
Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams
External Engagement
Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support
Additional Responsibilities
Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services
Contribute to process improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes
Support cross functional teams with medical expertise, as needed
Provide consultation, training, and education to staff and community partners on relevant topics as needed
Train and mentor peers within the Medical Management team and assist with onboarding PH Medical Director new hires as needed
Maintain a Positive Environment
Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce
Actively establish and promote a positive, diverse, and inclusive working environment that builds trust with teammates
Ensure all staff are treated with respect and dignity
Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
Minimum Requirements
Education & Experience
Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field.
At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required.
Special Requirement
Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine).
Knowledge, Skills, & Abilities
Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures
Knowledge of Managed Care Principles
Knowledge of recent developments in the field of medicine
Microsoft Office Skills
Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations
Utilization Management experience
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact
[email protected].
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.