Medical Director (Remote New York)

New York US
Job Category: 
Medical Director
Home Care
Full Time
Remote , NY
Posting Date: 
January 25, 2019
Expiration Date: 
February 25, 2019

MD or DO with an active and unencumbered medical license.

Additional licenses in other states may be required, depending on the CareCentrix client payer account rules, which may require multiple state licenses to be held concurrently.

Minimum of 5 years’ experience in an area of relevant clinical practice, and prefer at least 3 years’ experience with supporting utilization management reviews, managed care programs or care delivery networks.

Expertise in the Post-Acute Care field, including current knowledge on best practices, as well as a general knowledge of requirements of regulatory and accreditation standards for payers and health care providers.


As the Medical Director of Post-Acute Care you will have clinical oversight of the Post-Acute Care (PAC) program for CareCentrix, performing the full range of PAC medical necessity reviews utilizing Industry standard criteria’s well as Client’s clinical criteria for Skilled Nursing Facility (SNF), Long Term Acute Hospital (LTACH)/Inpatient Rehabilitation Facility (IRF) as well as Home Health Service, DME and Home Infusion.


Consults with licensed and non-licensed associates on clinical issues related to authorization requests and clinical guidelines clinical criteria

Conducts medical necessity review in adherence with regulatory and compliance turnaround times on cases that may not meet clinical criteria, and issues adverse determinations as needed

Accepts and conducts case discussions as well as peer-to-peer consultations when requested by an ordering health care professional after an adverse determination has been issued, adhering to required timelines for this activity

Participates in CareCentrix Care Coordination, Utilization Management and Quality Improvement committees, and other Performance improvement activities as requested

Provides input into CareCentrix clinical guidelines, criteria and other decision support tools, including evaluations and recommendations on new and emerging technologies, and industry standard treatment protocols relevant to CareCentrix business Interfaces with key positions within CareCentrix including the Chief Medical Officer, Senior Medical Director and executive team members, and serves as a clinical resource for communications with clients and business partners.

Utilizes clinical integrity in all determinations

Collaborates with Health Plan clinical leadership as requested.

Participates in special projects and performs other duties as assigned 

Participates in case reviews with the CareCentrix clinical team and provides educational support as needed

Has consultations with practitioners in the field

Travels routinely to facilities where we have Nurse Liaisons for on-site observation, feedback and coaching of CareCentrix clinical team members

Successfully completes and passes Inter-rater reliability testing and random case audits

Achieves Service Level Agreement (SLA) metrics as required by health plan clients

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