Medical Director, Operations, Cardiovascular

Summary

Join Cohere Health as a Medical Director to lead a team of Cardiology Associate Medical Directors and conduct clinical reviews. This remote, full-time position involves overseeing a team, managing a remote workforce, identifying and resolving problems, developing standard operating procedures, and performing daily clinical reviews. You will provide timely medical reviews, make clinical determinations, document communication and decisions, conduct peer-to-peer discussions, support clinical guideline development, and stay updated on industry changes. The ideal candidate will have a strong background in cardiology, experience in managed care, and excellent communication and leadership skills. Cohere Health offers a competitive salary and benefits package.

Requirements

• Completed US-based residency program in Internal Medicine and fellowship program in Cardiology
• Board certification as an MD or DO with a current unrestricted state license to practice medicine - must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship

Responsibilities

• Lead a team of Cardiology Associate Medical Directors responsible for prior authorization clinical reviews and peer-to-peer discussions
• Inspire and motivate team members to perform at their best
• Demonstrated ability to oversee and collaborate with staff
• Proven experience managing a remote workforce and operating efficiently in a virtual environment
• Identify potential problems and points of friction and working to find solutions in order to maximize efficiency and revenue
• Develop and document standard operating procedures
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
• Perform clinical reviews on a daily basis (50%)
• Provide timely medical reviews that meet Cohere’s stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
• Use correct templates for documenting decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Support the clinical guidelines team in developing and reviewing the company’s clinical decision guidelines in conjunction with client guidelines and directives
• Perform timely review of Medical Coverage Policies for our clients
• Maintain awareness of any changes in the literature, standard of care, or regulatory guidance impacting the criteria by which the company reviews service requests
• Maintain necessary credentials and immediately informs Cohere of any adverse actions relating to medical licenses and/or board certifications
• Perform other duties as delegated

Preferred Qualifications

• 2+ years of managed care utilization review experience
• 1+ years of direct supervision/management experience, preferably in a utilization management or payor organization
• Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual)
• Membership in national and/or regional specialty societies
• Licensure in MN, VA, ND, IL, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
• Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
• Excels in a matrix organization
• Strong interpersonal, oral and written communication skills
• Ability to work remotely and meet telephonically and/or via video with clinical colleagues and other personnel
• Proficient in using a Mac laptop computer and the Google Suite of applications
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision

Benefits

• Health insurance
• 401k
• Bonus