Job Description - Assistant Medical Director (2400419)
Assistant Medical Director - (2400419)
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision, and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
This position has the option to work fully remote; Northeast Ohio residents preferred.
Responsibilities
- Provides clinical expertise to the utilization review process and determinations.
- Provides pre-determination reviews and reviews of claims determinations, providing clinical, coding, and reimbursement expertise.
- Ensures compliance with clinical goals through monitoring of care management performance.
- Ensures the appropriate and most cost-effective medical care is received.
- Recommends changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols.
- Assists in development and interpretation of medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.
- Provides guidance to case management team in the coordination of quality care.
- Performs other duties as assigned.
Qualifications
Education and Experience
- MD or DO from an accredited medical school with an active, unrestricted (state) license to practice medicine in the United States.
- Minimum of 5 years of established (clinical) care practice experience required.
- Physician reviewer experience in the insurance industry preferred.
Professional Certification(s)
- Board Certification in nationally recognized specialty (ABMS or AOA) is required.
- Active unrestricted license to practice medicine in the U.S.
Technical Skills and Knowledge
- Foundational windows-based computer skills, including typing, word processing, presentation, and internet research skills.
- Strong understanding of integration of evidence-based medicine and managed care principles.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees.
A Great Place to Work:
- We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse, and headset.
- Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available.
- On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
- Discounts at many places in and around town, just for being a Medical Mutual team member.
- The opportunity to earn cash rewards for shopping with our customers.
Excellent Benefits and Compensation:
- Employee bonus program.
- 401(k) with company match up to 4% and an additional company contribution.
- Health Savings Account with a company matching contribution.
- Excellent medical, dental, vision, life, and disability insurance.
- Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources, and assistance with work/life benefits.
- Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
- After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity, or adoption.
An Investment in You:
- Career development programs and classes.
- Mentoring and coaching to help you advance in your career.
- Tuition reimbursement up to $5,250 per year, the IRS maximum.
- Diverse, inclusive, and welcoming culture with Business Resource Groups.
About Medical Mutual:
Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders. We focus on developing products and services that allow us to better serve our customers and the communities around us.
At Medical Mutual and its family of companies, we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
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