Accountabilities

Serve as the specialty medical reviewer for vascular surgery cases that do not initially meet applicable medical necessity guidelines, as well as other imaging requests requiring specialist review.
Conduct clinical assessments and provide expert recommendations to support appropriate healthcare utilization and evidence-based decision-making.
Participate in peer-to-peer telephone discussions with requesting physicians and ordering providers to explain clinical determinations within applicable regulatory timeframes.
Provide clinical rationale and medical expertise for standard and expedited appeals.
Apply established medical review guidelines, clinical parameters, and utilization management procedures to ensure consistent and appropriate medical decisions.
Ensure compliance with internal policies and applicable accreditation and quality standards, including Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) requirements.
Act as a clinical resource and provide guidance and support to initial clinical reviewers, helping strengthen the quality and consistency of medical assessments.
Maintain accurate, complete, and timely documentation of all communications with healthcare providers, medical office staff, and other relevant stakeholders.
Participate in ongoing training and inter-rater reliability activities to maintain consistent clinical review standards.
Support the Senior Medical Director with research, clinical questions, guideline interpretation, utilization management processes, and system-related initiatives.
When requested, assume Medical Director responsibilities for selected health plans or geographic regions, maintaining overall accountability for utilization management activities in collaboration with senior leadership.
Work closely with physicians, management teams, and clinical stakeholders to promote high-quality, patient-centered, and cost-effective healthcare decisions.

Requirements

MD, DO, or MBBS degree is required.
Current, unrestricted medical license in the relevant specialty is required.
Ability to obtain and maintain medical licensure in the state of residence.
Active board certification in Vascular Surgery, or active board certification in General Surgery combined with extensive professional experience in Vascular Surgery.
A minimum of five years of professional experience practicing as a vascular surgeon is preferred.
Strong clinical judgment and the ability to evaluate complex medical cases against established clinical guidelines and medical necessity criteria.
Excellent communication and interpersonal skills, including the ability to conduct effective peer-to-peer discussions with physicians and explain clinical decisions clearly.
Strong organizational and time-management skills, with the ability to manage clinical reviews, appeals, and documentation within required deadlines.
Experience or familiarity with utilization management, clinical quality assurance, medical necessity reviews, or healthcare accreditation standards is an advantage.
Good management and collaboration skills, with the ability to support clinical reviewers and work effectively with multidisciplinary teams.
Computer proficiency and the ability to use digital systems and software for clinical reviews, documentation, and communication.
A proactive, energetic, and curious approach, with a genuine commitment to healthcare quality, clinical excellence, and value-based care.
Ability to work independently in a remote environment while maintaining effective communication and collaboration with colleagues.
Reliable high-speed home internet connection exceeding 10 Mbps. Direct connection to the home internet router is required for employees performing call center-related duties.
Willingness to complete the required identity verification, employment eligibility verification, and comprehensive background screening. Additional screening, including drug testing, may apply before employment.

Benefits

Competitive compensation based on qualifications, clinical expertise, and professional experience.

How Jobgether works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

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