You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
We are seeking a qualified SUD MD Reviewer to conduct a retrospective utilization management overread of residential and inpatient denial decisions made by managed care entities for a state Medicaid program. This project involves evaluating historically denied cases to determine if standard clinical criteria were appropriately applied. Because these are retrospective reviews, they will have no impact on current member care or prior service outcomes.
Key Responsibilities
- Review escalated cases and render a definitive decision to agree or disagree with the original MCE denial.
- Evaluate whether ASAM (American Society of Addiction Medicine) criteria were correctly and fairly applied to each case.
- Leverage The ASAM Navigator by InterQual to guide and support your determinations.
- Efficiently document brief, clear case summaries within a secure Microsoft SharePoint environment.
Qualifications
- Must hold an MD with an active, unrestricted medical license. (Please note: DO credentials cannot be accepted for this specific role).
- Demonstrated expertise in ASAM criteria and extensive experience in Substance Use Disorder (SUD) treatment, ideally within inpatient or residential settings.
Skills
- Technical skills: Expertise in ASAM criteria and experience with InterQual platforms.
- Soft skills: Strong documentation and decision-making skills.
Additional Requirements
Work is 100% remote and offers flexible hours.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
Required Employment / Compliance Language
Medix is an equal opportunity employer. We are committed to creating a diverse and inclusive environment for all employees.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
