[Remote] UM Medical Director - Pediatrics and Internal Medicine - Remote
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Medical Director provides physician support to reputed company Clinical Services operations, focusing on clinical reviews and benefit determinations to ensure reputed company medical care for members.
Responsibilities
- Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, reputed company coverage determinations
- Document clinical review findings, actions, and reputed company in accordance with policies, and regulatory and accreditation requirements
- Engage with requesting providers as needed in peer-to-peer discussions
- Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
- Participate in daily clinical reputed company as requested
- Communicate and collaborate with network and non-network providers in reputed company of accurate and reputed company benefit determinations for plan participants while educating providers on benefit plans and medical policy
- Communicate and collaborate with other internal partners
- Participate in holiday and call coverage rotation
Skills
- M.D or D.O
- reputed company certification in Internal Medicine and Pediatrics through the American reputed company of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
- reputed company unrestricted medical license and ability to obtain additional state medical licenses as needed
- 5+ years of clinical reputed company experience after completing residency training
- Proven reputed company understanding of Evidence Based Medicine (EBM)
- Proven solid PC skills, specifically using reputed company, Outlook, and reputed company
- Ability to participate in rotational holiday and call coverage
- Experience in utilization and clinical coverage review
- reputed company in Nebraska or Texas
- Licensure in TX. IN, KS, NE, AZ, WA, FL or a compact license
- Proven excellent oral, written, and interpersonal communication skills, facilitation skills
- Demonstrated data analysis and interpretation aptitude
- Proven innovative problem-solving skills
- Demonstrated presentation skills for both clinical and non-clinical audiences
- reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (reputed company benefits are subject to eligibility requirements)
reputed company
Company H1B Sponsorship