Description & Requirements

Join a Mission-Driven Team Shaping the Future of Medical Review Standards

Are you a strategic medical leader with a passion for quality and education? We're seeking a dynamic Medical Director to oversee high-impact initiatives that influence care delivery and compliance across multiple benefits systems-including Workers' Compensation, Disability, and Paid Family Leave. In this pivotal role, you'll lead the development of training programs, guide clinical quality assurance, and drive innovation in medical review processes. If you're ready to make a meaningful difference at the intersection of clinical excellence and public service, we want to hear from you.

***Please note that this position is contingent upon contract award***

Essential Duties and Responsibilities:
- Direct the development of training materials for nurses and physicians.
- Oversee quality assurance of nurse and physician work product.
- Provide advice and counsel to the client as directed.

Additional Duties and Responsibilities:

- Oversees the review and provision of independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.

- Oversees the evaluation of Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.

Minimum Requirements

- Directs and controls the activities of a broad functional area through several department managers within the company.
- Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods.
- Works on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
- Participates in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
- Ensures budgets and schedules meet corporate requirements.
- Regularly interacts with executives and/or major customers.
- Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
- Reports to Senior Director or VP level.

- Part Time Worker Job Profile

Additional Minimum Requirements:

- Bachelors degree in relevant field of study and 10 years of relevant professional experience required.

- Candidates must hold a current M.D. and be licensed to practice medicine.

- Demonstrated knowledge of Workers' Compensation medical treatment guidelines required.

- Minimum of 3 years' experience serving as a Medical Director in a healthcare, managed care, or regulatory organization required.

- Proven ability to lead clinical teams, manage quality assurance, and advise senior leadership.

- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US

Preferred Qualifications:

- Board certification or clinical background in internal medicine.

- Experience working with external review organizations (EROs) or independent medical review panels.

- Understanding of medical necessity criteria and third-party review standards.

EEO Statement

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Minimum Salary

$

104.00

Maximum Salary

$

115.00