- 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 - Louisiana, United States - Summit Consulting
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
Job Requirements
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.
Great American Insurance Group understands the importance of choosing a financially strong company. We are an organization built for the long term and are committed to giving you that strength.
Why can you trust Great American Insurance Group? For nearly 150 years, Americans have trusted us to protect them. Our innovative insurance solutions and specialization serves niche marketplaces that we know well. This expertise gives us a successful foundation that spans generations.
You never know where a career in insurance will take you. Whether you are starting your career or are looking for a company to grow your experience, at Great American Insurance Group, you can join our more than 8,100 employees to "Be Here. Be GREAT"
To learn more, visit our Career Page
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