Medical Director Denials Management

Commitment: Full-Time

Office Location: Newtown Square, PA with remote opportunities available

Versalus Health provides data-driven solutions combined with clinical operations support to hospitals and health systems to help them enhance Medicare compliance and improve financial performance. Versalus Health was founded by industry leaders who established the standard for reviews of Medicare short-stay cases and remain trusted advisors to hospitals across the country.  

As a Medical Director, Denial Management, you’ll have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor to Versalus Health’s client hospitals. You will perform clinical case reviews and provide recommendations that focus on establishing the appropriate admission status. Versalus Health offers a career path that allows you to continue using your clinical knowledge, drive value to hospitals while providing you with a predictable schedule. This opportunity allows for the work/life balance you desire while expanding your knowledge base in Utilization Review. 

The Impact You Will Have:

Versalus Health is led by like-minded clinicians who share the same innate calling to help. Over the last 20 years, many hospitals have struggled financially due to complex regulations and policy changes set forth by Medicare and private payer organizations. Versalus Health physicians lead challenging and rewarding careers by providing our hospital clients with guidance to improve compliance and ensure appropriate payment for the care delivered. Your direct impact will not only help the hospitals we serve, but also the communities that rely on their services and physicians providing hands-on care.

Your Schedule:

Training (The first 3-4 weeks):

  • Training will occur Monday-Friday 9A-5P ET

After Completion of Training:

  • Schedule will be Monday-Friday, anywhere between 8a-5p ET to 10a-7p ET
  • Includes an expectation of 2 weekend 6 hour shifts of “prep” for peer-to-peer cases, within a 6-week business period.

In This Role You Will:

  • Perform Peer-to-Peer case discussions with payer medical directors
  • Utilize clinical expertise to identify the salient points within a case review
  • Perform focused real-time and post-discharge hospital case reviews in hospital’s EMR
  • Identify areas of process improvements and inefficiencies
  • Perform related duties and projects as assigned

Do You Have What it Takes?

  • MD or DO degree with strong clinical knowledge
  • Active unrestricted medical license in at least one state within the United States
  • Required specialization in Adult Internal Medicine, Emergency Medicine, Hospitalist, Nephrology, or Infectious Disease; Board certification (preferred)
  • At a minimum, 1 year of acute care adult hospital experience in a US hospital within the past 5 years or recent relevant physician advisor experience
  • Working knowledge of hospitals’ EMR
  • Computer proficient
  • Excellent verbal and written communication skills
  • Team Player

We Offer:

  • Quality of life with a remote predictable, full-time schedule
  • Comprehensive training and education program
  • Opportunities for career growth within the organization
  • Salary plus bonus opportunities**
  • Medical, Dental, Vision coverage, 401K**
  • Holidays, paid time off, short term and long-term disability insurance, and life insurance**
  • Allowance for CME and/or license renewals

**Full-time hours apply

Physical Requirements:

Physical requirements include, but not limited to, sitting for extended periods of time, repetitive movement of hands/fingers (i.e., typing and/or writing), and ability to talk and hear.

Versalus Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law.

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