- Review medical treatment plans for complex claims referred by the managed care team, discuss claims management with treating physicians, and advise internal nurse case managers on appropriate actions.
- Respond to questions submitted by managed care.
- Review external clinical guidelines and review and update internal guidelines and policies to meet specific objectives and improve claim outcomes.
- Ensure medical accuracy and quality by reviewing samples of peer reviews and independent medical exams. Comply with other internal Quality Assurance activities as required by URAC and other accrediting bodies.
- Provide oversight/review of clinical content for internal training programs. Facilitate and participate in new hire and on-going training of clinical personnel (MDs, RNs) when required.
- Explore and disseminate significant updates/changes in internal medical policies to claims managers and the managed care team. Evaluate decision support tools such as treatment guidelines and protocols to support Claims.
- Participate in and provide medical advice to internal steering committees with various missions as well as task forces relating to specific issues/problems.
- Serve as a medical resource for a variety of activities, including Legal, Loss Prevention, and Business Development.
- May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
- Performs other duties as assigned.
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Medical Director - Lakeland, United States - Great American Insurance Company
Description
Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers' comp, we strive to provide an atmosphere of constant growth and development for our employees.
Summit provides workers' compensation programs and services to thousands of employers throughout the Southeast.
Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it's underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.
Essential Job Functions and Responsibilities
It's one thing to know workers' comp. It's another to know people. But knowing both? That creates an altogether different experience.
So, if you're ready for an altogether different workplace experience, get to know the people who know workers' comp. Apply today.
Education: Board certified, licensed, practicing physician (MD or DO).
Field of Study: Medicine.
Experience: 5 or more years of clinical practice experience. Experience with workplace issues, short and long term disability, and workers compensation. Expertise with occupational and orthopedic illness/injuries.
Company:
SCI Summit Consulting, LLC
Benefits:
We offer competitive healthcare, retirement, and paid time off benefits for full-time and part-time benefit eligible employees.
