Medical Director - Philadelphia, PA, United States - ProgenyHealth, LLC

Description

ProgenyHealth empowers our health plan and employer partners to change the trajectory of maternal and infant health outcomes across America. Informed by more than 20 years of experience and patient data, our end-to-end maternal and infant care management solution helps ensure the best possible outcomes for every expecting mother we touch. Our wholly integrated solution builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. From the very beginning, we unite early health risk assessment data with self-directed digital tools and dedicated Case Managers who work tirelessly to connect at-risk moms-to-be with the resources, care, and support they need for a healthy, full-term delivery. By promoting predictable, equitable, and standardized high quality care journeys, we ensure healthier outcomes—and lower costs— across your entire at-risk population. In so doing, we help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

Job location: This position may be performed remotely in the US only

Job Role

The Medical Director will support the ProgenyHealth Clinical Operations team of neonatologists and NICU nurses and social workers by providing clinical expertise and reviewing market trends. With a focus on evidence-based care, the role optimizes performance internally and externally with hospital physicians and utilization management staff at hospitals. The Medical Director will work closely with ProgenyHealth NICU nurses reviewing available clinical information, partnering with providers, conducting medical necessity reviews and facilitating discharge planning. This includes:

• Rounding with ProgenyHealth clinical care nurses and case managers to offer recommendations, support and clinical expertise to assist with concurrent review of cases for medical necessity based on criteria, guidelines and clinical judgment.
• Conducting medical necessity reviews on inpatient stays as needed. as needed.
• Proactively call attending physicians, as needed, to discuss and clarify medical/surgical plans of care and any discharge planning needs, or to make recommendations supporting evidence based best practices when variations in care are identified.
• Responding to requests for a peer to peer conversation or other medical management discussion from/with an attending or ordering provider to discuss a case, determination, or other matter.
• Identifying and addressing Quality of Care issues; participating in Quality Improvement programs
• Ensuring fair and consistent decision making through the use of approved criteria and guidelines, and providing guidance; and is responsible for all clinical aspects of Medical Management.
• Preparing and delivering clinical educational presentations to staff when requested.
• Striving to exceed customer expectations and serving to support the desired image of excellence of service.

Qualifications

• MD/DO degree and Board Certified in Neonatal-Perinatal medicine required
• Minimum of five years clinical practice experience in Neonatal medicine after fellowship
• A minimum of 1 year experience in a managed care environment, or relevant hospital experience as a physician advisor or medical director, preferred.
• Must be organized, self-motivated and willing to learn multiple tasks.
• Must have excellent computer skills and be proficient in Microsoft Office (Outlook, Excel, Word, PowerPoint)
• Active, unrestricted license to practice medicine.

Some of the benefits we offer our team are:

• Paid Time Off
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance

Accessibility: If you need an accommodation as part of the employment process please contact Human Resources at
Phone: x 6
Email: Equal Opportunity Employer, including individuals with disabilities and veterans. If you want to view the Know Your Rights: Workplace Discrimination is Illegal poster, please choose your language: English – Spanish – Arabic - Chinese If you want to view the Pay Transparency Policy Statement, please click the link: English
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