Physician Medical Director - Competitive Salary

Job Description

New: Part-Time Medical Director Opportunity in Michigan!!\n
\nPosition Available: Medical Director, MD or DO, preferably in a general field of medical practice.\n
\nPosition Available due to Retirement.\n
\nStart Date: As soon as possible.\n
\nPractice Setting: This position works at a health plan.\n
\nNO Call\n
\nHours: The position is a part-time role and the hours worked are negotiable.\n
\nPractice Description: It is a Michigan based nonprofit voluntary employees’ beneficiary association. We provide our members and their families with comprehensive medical and prescription coverage and outstanding personal service. We also offer vision, dental and short-term and long-term disability benefits.\n
\nSpecific Skills or Certifications Needed: 10+ years of experience as a physician; Board certification; unrestricted license in the state of Michigan; the job description notes other minimum qualifications.\n
\nOrganization provides insurance and customer service to public employees and their families; a majority of our members work in Michigan public schools. We serve about 66,000 members plus their families (about 180,000 total covered lives).\n
\nThis position does not have a patient load, per se. The medical director reviews a variety of cases weekly to determine medical necessity. Cases involved relate to preauthorization of medical services, disability case determinations and appeals. The incumbent medical director completes this work in less than 20 hours per week and with support from registered nurses.\n
\nCompensation: The position is an independent contractor for which we negotiate an hourly base rate. We reimburse for all reasonable and approved expenses incurred in connection with the performance of approved services based on Organization travel and expense reimbursement policies \n
\nOrganization shall maintain professional liability insurance with minimum limits of $100,000/$300,000. Organization will pay the premium for this liability insurance.        \n
\nSERVICE POPULATION: 180,000 members, primarily public employees and their families.\n
\nThe independent consulting agreement will be reviewed regularly. The medical director shall maintain all licenses necessary to practice medicine in the state of Michigan and such other licenses as may be required to satisfy obligations under a consulting agreement negotiated between the parties. Organization will reimburse for fees associated with maintaining Board Certifications as follows: exam fee (not to exceed $2,000), exam preparation materials (not to exceed $1,000) and exam preparation course fee (not to exceed $2,500).\n
\nJOB DESCRIPTION:\n
\nThe medical director will consult with and advise Organization on providing quality\n
\nhealthcare and disability coverage to it's members. The medical director will work\n
\nwith Organization and its underwriters on matters of medical necessity, quality and\n
\nreasonableness of medical treatment in concurrent reviews and in appeals decisions.\n
\nThis position is that of an independent contractor; it involves approximately 20 hours per\n
\nweek. It is based in Mich., and may be partly remote.\n
\nIt is a Michigan-based nonprofit voluntary employees’\n
\nbeneficiary association (VEBA). We provide our members and their families with the\n
\nlargest provider network in Michigan, comprehensive medical and prescription coverage\n
\nand outstanding personal service. We also offer vision, dental and short-term and longterm\n
\ndisability benefits.\n
\nWe believe the hardworking people who care for our kids, our schools and our\n
\ncommunities deserve exceptional health benefits and unmatched personal service.\n
\nOrganization is deeply committed to diversity and inclusion. We are an affirmative action,\n
\nequal opportunity employer. People of color, women, and members of other historically\n
\nmarginalized social identity groups are encouraged to submit a letter of interest.\n
\nThe medical director:\n
\n• Performs physician-level review of medical and disability claims and\n
\npreauthorization requests for coverage determinations.\n
\n• Determines medical necessity of requests, including appeals, using medical\n
\npolicy, established guidelines or current research\n
\n• Serves as a clinical resource and subject matter expert to both clinical and nonclinical staff\n
\n• Recommends clarifications and updates to medical benefits, including assisting in\n
\nidentifying experimental/investigational treatment(s) and newer technologies,\n
\nsurgeries and medications\n
\n• Participates in quality initiatives, case management accreditation and utilization\n
\nmanagement to identify opportunities for improvement\n
\n• Participates in pharmacy initiatives and reviews of requested prescription drugs\n
\n• Reviews requests for over-age dependents, including appeals\n
\n• May be asked to participate in committees and workgroups to achieve department\n
\nand organizational objectives\n
\n• Various other duties as the need arises\n
\nMinimum Qualifications\n
\nCurrent unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license\n
\nDoctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.)\n
\n10+ years of experience as a physician, preferably in a general field of medical practice\n
\nBoard certified\n
\nResults-oriented and has the ability to take ownership of work\n
\nStrong communication and interpersonal skills\n
\nStrong analytical skills\n
\nAbility to work both independently and within a team environment\n
\nUnderstanding of health plan functions related to utilization, care and quality management.