Serve as the specialty match reviewer in Vascular cases, that do not initially meet the applicable medical necessity guidelines
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available
Provides clinical rationale for standard and expedited appeals
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process
Aids and acts as a resource to Initial Clinical Reviewers
Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner
Participates in on-going training per inter-rater reliability process
May assist the Senior Medical Director in research activities/questions related to the Utilization Management process

MD/DO/MBBS
Required
Minimum of five (5) years’ experience in the practice of Vascular Surgeon
Preferred
Current, unrestricted clinical license in medicine or required specialty
Required
Obtaining and maintaining medical licenses in the state you reside and licensure per business need
Required
Active Board Certification in Vascular Surgery or Active Board Certification in General Surgery with extensive experience in Vascular Surgery
Required
Strong clinical, management, communication, and organizational skills-Required
Energetic and curious with a passion for quality and value in health care-Required
Computer Proficiency-Required

Field Medical Director, Vascular Surgery

Key skills