Job title
utilization management physician advisor medical director role.
key responsibilities:
* lead comprehensive utilization reviews of patient admissions, services, and length of stay to ensure medical necessity against established criteria.
* conduct concurrent chart reviews to guarantee clinical documentation supports the level of care provided.
* act as a liaison between treating physicians and payers facilitating discussions on patient care and documentation requirements.
* analyze and appeal clinical denials through 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.
* document all actions and outcomes meticulously in the electronic medical record system.
* participate in peer review meetings contributing 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.
* personal and professional integrity.
* 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.