Required skills & experience :
1. Graduate of a recognized medical school and recipient of an M.D. degree.
2. Must possess at least a current, unrestricted medical license and the ability to obtain licensure in multiple states.
3. At least 3 years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice.
4. Understanding of population-based medicine with preference given to significant experience with the Medicare population.
Skill set: Utilization review / Utilization management for post-acute care cases (geriatrics)
Salary: $240-250K/year with 20% annual dependent on company and independent performance
• Benefits including: medical, dental, vision, 401k with company match, 23 days of PTO, 10 paid holidays
Job Summary: Seeking a board certified Medical Director. The Medical Director will partner with cross-functional teams and senior leaders to ensure that your company leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role is a physician leader with a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping your companies corporate-wide strategies.
• Provide daily utilization oversight and external communication with network physicians and hospitals.
• Responsible for daily UM reviews – authorizations and denial reviews.
• Conduct peer to peer conversations for the clinical case reviews, as needed.
• Conduct provider telephonic review and discussion, schedule on-site visits, and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care.
• Communicate effectively with network and non-network providers to ensure the successful administering of companies services.
• Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers.
• Represent companies on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders.
• Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers.
• Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals. • Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees.
• Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting.
• Regularly meet with companies leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues.
• Provide input on local needs for Analytics Team and Client Services Team in order to better enhance companies products and services.
• Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME.
• Participate on Medical Advisory Board.
• Perform other duties and responsibilities as required, assigned, or requested.
Required Skills and Experience:
• Graduate of a recognized medical school and recipient of an M.D. degree.
• Must possess at least a current, unrestricted medical license and the ability to obtain licensure in multiple states.
• At least 3 years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice.
• Understanding of population-based medicine with preference given to significant experience with the Medicare population.
• Strong business acumen, including working knowledge of changing U.S. payer and provider landscape.
• Excellent organizational, verbal and written communication and presentation skills.
• Ability to work with others while completing multiple tasks simultaneously and successfully.
• Ability to complete assignments with reasonable oversight, direction, and supervision.
• Highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment.
• Strong interpersonal skills and necessary business acumen in order to communicate and build positive relationships with management.
• Clear, concise and persuasive verbal and written communication. Must be able to positively interact with other clinicians, senior management, patients and their families, and all levels of medical and non-medical professionals.
• Excellent analytic skills. Patient demographic: Medicare Advantage patients within the top 30 percentile for risk of readmission to hospital Physicians will see 35 patients/day on average Preferred Experience:
• 2+ years in Utilization Review/Geriatric Medicine
• Prior work with medicare/medicare advantage is a plus
• SNF or LTC is great
Typical 8a-5p. Opportunity to work more/make more money with on call scheduling.