[Hiring] Part-time Associate Medical Director - Utilization Review @MRIoA

Role Description

In this role, you will apply your clinical expertise to evaluate requests for medical services, interpret benefit language and medical policies, and make sound coverage determinations. You may also engage in peer-to-peer discussions with treating providers. This position emphasizes independent clinical judgment, thorough documentation, and collaboration with a nationwide team of Medical Directors.

Core Responsibilities

• Perform clinical coverage reviews using member benefits, medical policies, and established clinical guidelines.
• Interpret benefit language to support accurate and compliant determinations.
• Document review outcomes in alignment with regulatory, accreditation, and internal standards.
• Participate in peer-to-peer discussions with treating providers as needed.
• Collaboration with Medical Directors across multiple specialties and regions.

Work Schedule

• 10-30 hour per week requirement.
• Flexible (but prescheduled) shifts between the hours of 6:00 a.m. - 7:00 p.m. MST (8:00 a.m. – 9:00 p.m. EST).
• Strong preference for shifts to be scheduled in 4-hour blocks (6a-10a, 10a-2p, 2p-6p or 3p-7p Mtn time).
• Must commit to 2 weekend shifts per month (4 hour shifts minimum).
• Schedules are determined by physician and fixed 2 months in advance.
• Dedication during scheduled hours is required.

Qualifications

• Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state.
• Hold current board certification in either Family Medicine or Internal Medicine (no other board-certified specialty is currently needed).
• Possess a minimum of 5 years of direct patient care experience.
• High level of computer proficiency and comfort with multiple software programs.
• Ability to be fully dedicated during scheduled work hours (Caregiving or other responsibilities during work hours are not permitted).
• Must reside and work within the United States.

Requirements

• This is a part-time (W2), non-benefited role.
• Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy.
• All necessary computer equipment is provided.
• For security, computers must be hard-wired via Ethernet (Wi-Fi is not permitted).

Work Environment

• Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required.
• This role is designed to be a remote position (work-from-home).

Diversity Statement

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Drug-Free Workplace

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only)

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at [email protected].