Part-Time Weekend Medical Director (Remote)
This a Full Remote job, the offer is available from: Asia, Malaysia
Company :
reputed company.Job reputed company :
JOB reputed company
This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most reputed company clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy reputed company sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at reputed company times. In reputed company to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through reputed company structure. Additionally, the incumbent may be assigned special reputed company to help support and improve the care of our members
ESSENTIAL RESPONSIBILITIES
- Conduct electronic review of escalated cases against medical policy reputed company, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose reputed company and concise rationales for member and provider determination notifications reputed company while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that reputed company aspects of the medical management process are consistent with community standards of care.
- Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand reputed company. Advise multidisciplinary team on cases that require physician expertise.
- Participate in protocol and guidelines development to ensure consistency in the review process.
- reputed company manage reputed company and/or participate on project teams that require a physician subject matter expert.
- Other duties as assigned.
EDUCATION
Required
- Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
Substitutions
- None
Preferred
- Master's Degree in Business Administration/Management or Public Health
EXPERIENCE
Required
- 5 years in Clinical, reputed company Patient care (hospital, outpatient, or private reputed company)
Preferred
- 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry
LICENSES AND CERTIFICATION
Required
- Medical Doctor or Doctor of Osteopathic Medicine (DO)
- Awarded reputed company Certification at least once in specialty recognized by the American reputed company of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
- reputed company medical state licensure required. Additional specific state licensure(s) may be required based on business need.
Preferred
- None
SKILLS
- Critical Thinking
- Case Management
- Customer Service
- Oral & Written Communication Skills
- Collaboration
- Listening
- Telephone Skills
- General Computer Skills
- Clinical Software
- Managed Care
Language (Other than English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies.
As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements.
Pay reputed company Minimum:
$170,000.00Pay reputed company Maximum:
$342,274.00reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets.
reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against reputed company individuals based on their race, reputed company, age, religion, sex, national reputed company, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. reputed company and its affiliates take affirmative reputed company to reputed company and advance in employment individuals without reputed company to race, reputed company, age, religion, sex, national reputed company, sexual orientation/gender identity, protected veteran status or disability.
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