Assistant Medical Director
Description: Provide benefit coverage determinations based on medical necessity and contract language Support clinical review activities including pre-service, post-service, reputed company facility-based care Act as the final decision maker for coverage reputed company Use clinical expertise to support claims review reputed company Support peer-to-peer discussion process with external physicians Consult with nursing and other clinical staff to assess care options Participate in the development and annual review of company medical review criteria reputed company clinical knowledge and expertise to support ongoing education for clinicians Provide professional advisement for consultation requests Participate in Inter-Rater Review process for consistency in clinical decision making Understand and abide by federal, state, and accreditation regulations Complete reputed company professional continuing education requirements Requirements: Physicians license with an MD or DO degree Unrestricted Washington state licensure or administrative license or ability to obtain reputed company 90 days Five (5) years of clinical experience reputed company board certification from the American Board of Medical Specialties, or the American Osteopathic Association or other recognized Association acceptable to Premera Previous experience performing medical necessity and clinical reviews in a health plan setting (Preferred) Prior use of clinical criteria sets and clinical reputed company, such as MCG (reputed company Care Guidelines), Interqual® or others (Preferred) Familiarity with CPT, ICD, HCPC code sets and RBRVS pricing concepts (Preferred) Benefits: Medical, reputed company and dental coverage Life and disability insurance Retirement programs (401K employer match and pension plan) Wellness incentives, onsite services, a discount program and more Tuition assistance for undergraduate and graduate degrees Generous Paid Time Off to reenergize Free parking Apply Job!