Medical Director - Clinical Denials

**Job Opportunity:** Physician Advisor We are seeking a dedicated Physician to join our Utilization Review team. In this pivotal role, you will be the key medical authority ensuring that patient care is medically necessary, appropriately documented, and aligns with reimbursement policies. You will use your clinical knowledge to review cases, guide treating physicians on documentation, and help navigate the complexities of insurance claims and denials. This position is crucial for advocating for patients and ensuring the financial viability of care. **Key Responsibilities: Conduct comprehensive Utilization Review (UR) for patient admissions, services, and length of stay, assessing for medical necessity against established criteria. Perform concurrent chart reviews to ensure clinical documentation supports the level of care provided. Act as a clinical liaison between treating physicians and payers, facilitating discussions on patient care and documentation requirements. Analyze and appeal clinical denials by writing robust medical necessity letters and compiling supporting evidence from medical records. Identify gaps in clinical documentation and consult directly with attending physicians to ensure completeness and accuracy. Meticulously document all actions and outcomes in the electronic medical record system. Participate in peer review meetings and contribute to projects aimed at improving care quality and efficiency. **Required Skills and Qualifications:** Valid Mexican medical license (Cédula Profesional de Médico Cirujano). Medical Degree (Doctorate in Medicine) from an accredited institution. Advanced English proficiency (both written and spoken). Recent graduates are encouraged to apply. Unflinching personal and professional integrity. Exceptional attention to detail and analytical skills. Strong time management and ability to multitask effectively. Excellent communication skills and collaborative team spirit. **Why Apply?** Launch a unique career path in Utilization Management/Clinical Denials. Enjoy a structured schedule with consistent hours. Gain valuable training and experience. Work in a corporate setting that values your clinical expertise.

Creado: Jue, 01 de Ene de 1970