Medical Director, Post Acute Care
August 1, 2017
September 1, 2017
- Board Certification from an approved, pertinent ABMS Board with a current, valid and unrestricted license in the United States.
- Internal Medicine, Family Practice with or without subspecialty preferred, Physical Medicine and Rehabilitation Preferred
- At least 5 years of experience in direct patient care.
- Medical Management Experience is desired.
- Managed Care Experience is desired. Knowledge of applicable state and federal laws, URAC and NCQA standards
- Communication and presentation skills strongly preferred.
- Work under the direction of the Chief Medical Officer of Post-Acute Care to coordinate all clinical aspects of utilization and quality management activities for Post-Acute Care eviCore Services.
- Perform the full range of post-acute program medical necessity reviews utilizing nationally accepted medical necessity criteria for Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Long Term Acute Care Facility (LTAC) for admissions and length of stay appropriateness
- Utilize CMS guidelines, NCDs, LCDs, and appropriate guidelines (InterQual, Milliman and Robbins) in medical necessity determinations.
- Available for Peer to Peer consultations.
- Available to attending physicians and/or ordering providers to conduct peer to peer discussions concerning utilization management issues.
- Serve as an advisor on other clinical matters within area(s) of expertise.
- Support the Clinical Services Staff as needed.
- Participate in calls and meetings with clients as needed.
- Participate in special projects as needed.
- Assist in the Guidelines/Criteria updates as needed.
- Perform other duties as required by the Chief Medical Officer of Post-Acute Care.