Associate Medical Director - Cardiology (100% Remote) (Physician #)
Company: eviCore Healthcare
Posted on: September 13, 2019
Associate Medical Director Information Minimum 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
a clinical specialty recognized by the American Board of Medical
Specialties (ABMS), with recent practice experience in direct
patient care (within the past 18 months).
- Have at least 5 years of clinical experience (post
- 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 Responsibilities:
- 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
- Reviews appeals for denied services related to current relevant
medical experience or knowledge in accordance with appeal policies,
if so delegated.
- Provides timely peer-to-peer discussions with referring
physicians to clarify clinical information and to explain review
- Documents all actions related to clinical review sessions and
attests to appeal review qualifications as required.
- Maintains files of all reviews as required by law and Health
Plans to retrieve reportable data.
- Maintains necessary credentials and immediately informs eviCore
of any adverse actions relating to medical licenses and/or board
- Supports the annual review of utilization review criteria.
- Supports and communicates eviCore policy and procedures to the
- Participates in strategic planning for and evaluation of the
Care Management process/unit.
- Assists with staff educational training and in-service programs
and serves as a clinical resource for eviCore staff.
eviCore is committed to hiring and retaining a diverse workforce.
We are an Equal Opportunity Employer, making decisions without
regard to race, color, religion, sex, national origin, age, veteran
status, disability, or any other protected class. Applicants must
be able to pass a drug test and background investigation
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Keywords: eviCore Healthcare, Melbourne , Associate Medical Director - Cardiology (100% Remote) (Physician #), Executive , Melbourne, Florida
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