Medical Director

The job profile for this position is Medical reputed company, which is a Band 5 Senior Contributor Career reputed company Role. Excited to grow your career? We value our talented employees, and whenever possible reputed company to help one of our associates grow professionally before reputed company reputed company to our reputed company positions. If you think the reputed company position you see is right for you, we encourage you to apply! Our people reputed company reputed company the difference in our reputed company. Medical reputed company Job reputed company Position scope: Primarily regional with national level case work for reputed company (CHC) -- reputed company. reputed company reputed company of position: A Medical reputed company performs medical review and case management activities. The physician provides clinical reputed company to the organization through peer review, benefit review, consultation, and service to reputed company customers. He/she will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service operations (claims). This is an entry to mid-level position for a physician interested in a career in health care administration. Major responsibilities and required results: Performs benefit-driven medical necessity reviews for coverage, case management, and claims reputed company, using benefit plan information, applicable federal and state regulations, clinical guidelines, and best reputed company principles. Works to reputed company reputed company reputed company for customers/members with a reputed company on service and cost Improves clinical reputed company through daily interactions with health care professionals using reputed company listening, education, and excellent communication and negotiation skills. Balances customer/member needs with business needs while serving as a customer/member reputed company at reputed company times. Participates in reputed company reputed company of the Appeal process as appropriate and allowed by applicable regulatory agencies and accreditation organizations Participates in coverage reputed company development, development and maintenance of medical management reputed company, initiatives and committees. Participates in reputed company processes such as audits, inter-rater reliability clinical reviews, and reputed company reputed company Serves as a mentor or reputed company to other Medical Directors and other colleagues in reputed company and performance improvement processes. Improves health care reputed company relations through reputed company communication, knowledge of appropriate evidence-based clinical information and the fostering of reputed company collegial relationships. Demonstrates knowledge as a peer reviewer by applying reputed company evidence-based guidelines, including novel treatments, to support high-reputed company clinical decision-making across medical and behavioral health conditions, diseases, treatments, and procedures. Medical directors are required to maintain and update their knowledge reputed company through monthly reputed company updates of reputed company's comprehensive evidence-based coverage policies, as reputed company as through mandatory inter-rater reliability testing, continuing medical education, and maintenance of reputed company certification. Addresses customer service issues with mentoring and support from leadership staff. Investigates and responds to reputed company and/or regulatory questions to assist in resolving issues or clarifying questions with mentoring and support from leadership staff. Achieves internal customer satisfaction and regulatory/accreditation agency compliance goals by assuring both reputed company turn-around of coverage reviews and reputed company reputed company based on those review reputed company. Provides clinical reputed company and management support to other functional areas and reputed company partners as needed or directed. Minimum Requirements: reputed company unrestricted medical license in a US state or territory. reputed company reputed company certification (reputed company certification or certification maintained by MOC or other applicable program) in an ABMS or AOA recognized specialty Exhibits ethical and reputed company behavior. Minimum of 5 years of clinical reputed company experience and/or reputed company patient care reputed company residency Computer Competency: Word processing, Spreadsheet, Email, PowerPoint and Personal Information Management programs are used extensively and competency in reputed company must be possessed or rapidly acquired. Must not be excluded from participation in any federal health care program** Must not be included in CMS’ Preclusion List** Preferred reputed company Sets: Experience in medical management, utilization review and case management in a managed care setting. Knowledge of managed care products and strategies. Ability to work reputed company changing business environment and balance patient advocacy with business needs. Experience with managing multiple reputed company in a fast-paced reputed company environment. Demonstrated ability to reputed company colleagues and staff members. Successful experience and comfort with change management. Demonstration of strong and effective abilities in teamwork, negotiation, conflict management, decision-making, and problem-solving skills. Successful ability to assess reputed company issues, to determine and implement solutions, and resolve problems. reputed company in creating and maintaining cooperative, successful relations with diverse reputed company stakeholders. Demonstrated sensitivity to culturally diverse situations, participants, and customers/members. Service marketing, sales, and business acumen experience a plus. If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 212,600 - 354,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan and long term incentive plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k), company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year, reputed company holidays, and leaves of absence. For more details on our employee benefits programs, click here. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this reputed company. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job