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Associate Medical Director of Heart Health
hace 2 semanas
We are a company that believes in connecting the pieces of the fragmented healthcare system to ensure that everyone receives the same level of care and compassion. Our team consists of experts who are passionate about value-based care and improving healthcare quality.
Job Description
This position is a unique opportunity to impact patient care beyond direct clinical practice. As an Associate Medical Director – Cardiovascular Medicine, you will serve as a specialty-matched expert for cardiovascular utilization management and next-generation idea and value creation. You will work closely with cross-functional teams, including clinical reviewers, management, and senior leadership, to improve decision-making and care outcomes. Your key responsibilities will include providing clinical expertise in utilization management (UM), ensuring high-value care aligned with national guidelines, processing improvement and enhancement of peer-to-peer discussions with requesting physicians to guide appropriate clinical decision-making, offering clinical rationale for standard and expedited appeals, ensuring compliance with UM policies and regulatory requirements, and supporting special projects as needed, including potential oversight of utilization management for select health plans or regions.
Requirements
The ideal candidate will have an MD/DO/MBBS degree with active ABIM Board Certification in Cardiology, unrestricted medical license in the state of residence, willingness to obtain additional state licensure as needed, minimum 5 years of clinical experience in cardiology, 3+ years of UM experience preferred, strong clinical judgment, communication, and organizational skills, passion for value-based care and improving healthcare quality, computer proficiency, and ability to navigate electronic medical review platforms. No current exclusions, sanctions, or disciplinary actions by state or federal healthcare programs are required.
Benefits
We offer comprehensive benefits, including health insurance benefits, to qualifying employees. Our total compensation package includes a competitive salary range and bonus component based on pre-defined performance factors.
