Job Description

Medical Director Physician at DOCTORS CHOICE PLACEMENT SERVICES, INC. summary:

The Medical Director Physician is a part-time, independent contractor role based in Michigan, overseeing medical necessity reviews and disability case determinations for a nonprofit health plan serving public employees and their families. The director evaluates medical claims, conducts appeals, and participates in quality initiatives to ensure effective health coverage and utilization management. This role requires over 10 years of clinical experience, board certification, and an active Michigan medical license, with work performed approximately 20 hours per week, partly remote.

New: Part-Time Medical Director Opportunity in Michigan
Position Available: Medical Director, MD or DO, preferably in a general field of medical practice.
Position Available due to Retirement.
Start Date: As soon as possible.
Practice Setting: This position works at a health plan.
NO Call
Hours: The position is a part-time role and the hours worked are negotiable.
Practice Description: It is a Michigan based nonprofit voluntary employees beneficiary association. We provide our members and their families with comprehensive medical and prescription coverage and outstanding personal service. We also offer vision, dental and short-term and long-term disability benefits.
Specific Skills or Certifications Needed: 10+ years of experience as a physician; Board certification; unrestricted license in the state of Michigan; the job description notes other minimum qualifications.
Organization provides insurance and customer service to public employees and their families; a majority of our members work in Michigan public schools. We serve about 66,000 members plus their families (about 180,000 total covered lives).
This position does not have a patient load, per se. The medical director reviews a variety of cases weekly to determine medical necessity. Cases involved relate to preauthorization of medical services, disability case determinations and appeals. The incumbent medical director completes this work in less than 20 hours per week and with support from registered nurses.
Compensation: The position is an independent contractor for which we negotiate an hourly base rate. We reimburse for all reasonable and approved expenses incurred in connection with the performance of approved services based on Organization travel and expense reimbursement policies
Organization shall maintain professional liability insurance with minimum limits of $100,000/$300,000. Organization will pay the premium for this liability insurance.
SERVICE POPULATION: 180,000 members, primarily public employees and their families.
The independent consulting agreement will be reviewed regularly. The medical director shall maintain all licenses necessary to practice medicine in the state of Michigan and such other licenses as may be required to satisfy obligations under a consulting agreement negotiated between the parties. Organization will reimburse for fees associated with maintaining Board Certifications as follows: exam fee (not to exceed $2,000), exam preparation materials (not to exceed $1,000) and exam preparation course fee (not to exceed $2,500).
JOB DESCRIPTION:
The medical director will consult with and advise Organization on providing quality
healthcare and disability coverage to it's members. The medical director will work
with Organization and its underwriters on matters of medical necessity, quality and
reasonableness of medical treatment in concurrent reviews and in appeals decisions.
This position is that of an independent contractor; it involves approximately 20 hours per
week. It is based in Mich., and may be partly remote.
It is a Michigan-based nonprofit voluntary employees
beneficiary association (VEBA). We provide our members and their families with the
largest provider network in Michigan, comprehensive medical and prescription coverage
and outstanding personal service. We also offer vision, dental and short-term and longterm
disability benefits.
We believe the hardworking people who care for our kids, our schools and our
communities deserve exceptional health benefits and unmatched personal service.
Organization is deeply committed to diversity and inclusion. We are an affirmative action,
equal opportunity employer. People of color, women, and members of other historically
marginalized social identity groups are encouraged to submit a letter of interest.
The medical director:
• Performs physician-level review of medical and disability claims and
preauthorization requests for coverage determinations.
• Determines medical necessity of requests, including appeals, using medical
policy, established guidelines or current research
• Serves as a clinical resource and subject matter expert to both clinical and nonclinical staff
• Recommends clarifications and updates to medical benefits, including assisting in
identifying experimental/investigational treatment(s) and newer technologies,
surgeries and medications
• Participates in quality initiatives, case management accreditation and utilization
management to identify opportunities for improvement
• Participates in pharmacy initiatives and reviews of requested prescription drugs
• Reviews requests for over-age dependents, including appeals
• May be asked to participate in committees and workgroups to achieve department
and organizational objectives
• Various other duties as the need arises
Minimum Qualifications
Current unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license
Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.)
10+ years of experience as a physician, preferably in a general field of medical practice
Board certified
Results-oriented and has the ability to take ownership of work
Strong communication and interpersonal skills
Strong analytical skills
Ability to work both independently and within a team environment
Understanding of health plan functions related to utilization, care and quality management.

Keywords:

Medical Director, Physician, Medical necessity review, Disability case determination, Health plan, Utilization management, Board certification, Medical policy, Quality initiatives, Independent contractor

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