Nonclinical Career Options for Physiatrists: Insurance Company Medical Director-CAREEROPS - Insurance Company Medical Director

Video Transcription

Video Summary

Dr. Mark Durden discussed his role as a medical director for Medicare and provided insights into working in insurance companies. He explained that Medicare is a defined benefit program and covered topics such as reviewing medical policies, writing LCDs (local coverage determinations), conducting medical review, and participating in appeals. Dr. Durden emphasized the importance of understanding the language of Medicare and learning the acronyms associated with it. He also highlighted the need for PM&R physicians in insurance companies as they possess specific knowledge and expertise in areas such as inpatient rehabilitation, durable medical equipment (DME), and chronic care needs. He suggested ways to get involved, such as becoming a tertiary reviewer for an insurance program, joining the Carrier Advisory Committee, and working as a medical director for Medicaid or Medicare Advantage programs. Dr. Durden concluded by addressing concerns about working for insurance companies and recommended learning the language of Medicare and understanding what is considered reasonable and necessary in order to become a better advocate for patients.

Keywords

Medicare

insurance companies

medical director

defined benefit program

medical policies

acronyms

PM&R physicians

inpatient rehabilitation

patient advocacy