Medical Director | Physician

Job Title: Medical Director | Physician
Job Location: Atlanta, GA 30338 (Remote)
Job Duration: 06 Months+ (Possible Extension)

Shift Time: 1st Shift – Early (Monday to Friday, 8:00 AM – 5:00 PM)
 
Position Overview:
The Medical Director is responsible for reviewing medical records, analyzing complex inpatient clinical cases, and making evidence-based medical necessity determinations. This role includes regular communication with external providers to clarify clinical information and ensure decisions align with national guidelines, CMS requirements, and company policies. The Medical Director works independently within a structured, team-based environment while meeting quality, productivity, and compliance standards.
 
Essential Job Functions:
• Conduct timely and compliant medical necessity reviews for inpatient services.
• Ensure determinations align with CMS requirements, national clinical guidelines (MCG®, InterQual), and company policies.
• Communicate medical decisions clearly and professionally in both written and verbal formats.
• Meet established productivity, quality, and compliance metrics.
• Collaborate with external providers and internal teams to support accurate clinical decision-making.
• Adapt to evolving workflows, utilization management tools, and operational practices.
 
Required Qualifications:
• MD or DO with an active, unrestricted medical license.
• Board certification in an ABMS-approved specialty.
• Minimum of 5 years post-residency or fellowship clinical experience, preferably involving inpatient or Medicare populations.
• Strong clinical judgment, analytical abilities, and communication skills.
• Ability to meet credentialing, compliance, and regulatory requirements.
 
Preferred Qualifications:
• Experience in Utilization Management, Medicare Advantage, Managed Medicaid, or Commercial Health Plans.
• Familiarity with MCG® or InterQual clinical guidelines.
• Clinical background in Internal Medicine, Family Medicine, Geriatrics, Hospitalist Med


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