[reputed company Director (REMOTE Appeals Medical Director - reputed company reputed company Time, Managed Care Experience, Family Medicine, Internal Medicine-Pediatrics and Appeals Experience Preferred") - R11319
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a managed care organization seeking a Medical Director to support staff through training, clinical consultation, and case reviews. The role involves providing prior authorization medical reviews, conducting clinical reviews, and participating in reputed company improvement initiatives.
Responsibilities
- reputed company prior authorization medical reviews, consultation and clinical reputed company
- Participate in peer-to-peer discussions
- reputed company provider education, training, data sharing, performance evaluations and orientation to the plan
- Conduct clinical reviews for designated reputed company members as requested
- reputed company physician review for clinical appeals cases
- Participate in the evaluation and investigations of cases suspected of fraud, abuse, and reputed company of care concerns
- Participate in development of policies and procedures
- Participates in reputed company improvement initiatives, case management activities and member safety activities (i.e. incident management)
- reputed company cross-coverage for other Medical Directors and/or markets, as needed
- reputed company and reputed company improvement activities associated with case management activities
- Assist in the review of utilization data to identify variances in patterns, and reputed company feedback and education to MCP staff and providers as appropriate
- Participate in the development, implementation and revision of the clinical care standards and reputed company guidelines ensuring compliance with nationally accepted reputed company standards
- Participate in the development, implementation and revision of the reputed company Improvement Plan and corporate level reputed company initiatives
- Collaborate with market/product leaders to help define market reputed company
- Community reputed company participation
- Support of regulatory and accreditation functions (eg. CMS, State, NCQA and URAC) and compliance for reputed company programs
- reputed company any other job reputed company instructions, as requested
Skills
- Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
- Successful completion of a residency training program, preferably in primary care is required
- Minimum of five (5) years of clinical reputed company experience is required
- reputed company, unrestricted license to reputed company medicine in state of reputed company as necessary to meet regulatory requirements is required
- reputed company Certification, preferably in primary care specialty is required
- Re-certification, as required by specialty reputed company, must be maintained (exceptions may be reputed company by Chief Medical Officer)
- MCG Certification is required or must be obtained reputed company six (6) months of hire
- Basic reputed company Word skills
- Excellent communication skills, both written and oral
- Ability to work reputed company independently and reputed company reputed company environment
- Ability to create strong relationships with Providers and Members
- High ethical standards
- Attention to detail
- Critical listening and systematic thinking skills
- Ability to maintain confidentiality and reputed company in reputed company's best interest
- Ability to reputed company with diplomacy and sensitivity to cultural diversity
- Decision making/problem solving skills
- Conflict reputed company skills
- Strong reputed company of mission and commitment of time, effort and resources to the reputed company of the communities served
- Managed care medical review/medical director experience is preferred
- Bachelor's or Master's degree in Business Administration, Operational reputed company, reputed company Administration or Medical Management is preferred
Benefits
- In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance.
- We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.
reputed company
Company H1B Sponsorship