Review clinical cases and determine medical necessity of services for Medicare and Medicaid members.
Ensure compliance with review policies, procedures, and regulatory standards.
Apply clinical guidelines, CMS policies, and Medicare/Medicare Advantage/Medicaid requirements.
Identify opportunities for medical management operational improvements.
Participate in call rotations, including weekend coverage and after-hours coverage.
Contribute to an engaged, collaborative team culture that supports organizational excellence.
Deliver exceptional consumer experiences.
Participate in educational activities by attending required conferences and creating content to present for individual subject matter contribution.
Support Home Solutions and other activities as assigned by the OneHome leadership.

MD or DO degree
Current, active and ongoing board certification from the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialties (AOABPS). National Board of Physicians & Surgeons (NBPAS) certification is not accepted.
Current and unrestricted state license in at least one state and willing to obtain other medical licenses, as required, for various states in region of assignment.
No sanctions from Federal or State Governmental organizations
5 years of direct clinical patient care experience post residency or fellowship.
The ability to pass credentialing requirements.
Intermediate to advanced skills utilizing Microsoft Office and Internet navigation.
Strong verbal and written communication skills, with the ability to analyze information and interpret data clearly and accurately.
Adaptable and willing to learn new technologies to enhance workflow efficiency.

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability
life insurance and many other opportunities

Medical Director

Key skills