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Grand Blanc

    Remote- Medical Director - Blank, United States - Allmed Staffing Inc

    Allmed Staffing Inc
    Allmed Staffing Inc Blank, United States

    3 weeks ago

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    Description

    Job Description

    Job Description

    Description:
    Job Summary
    The Market Medical Director for Utilization Management will support WellMed Medical
    Management, Inc. by making utilization management determinations, identifying utilization
    trends suggesting possible over or under utilization of services and proactively suggesting
    improvements to WellMed Medical Management's utilization management program. The
    position will also provide appropriate mentoring and leadership to physicians in the market as
    well as develop relationships to support growth and fiscal responsibility.
    Essential Job Functions

    • Assists in development and maintaining an efficient UM program to meet the needs of the
    health plan members and commensurate with company values.

    • Educates primary care physicians regarding systems, structures, processes and outcomes
    necessary for assurance of regulatory compliance related to market activities.

    • Develops strategies for improving all aspects of market performance including RAPS,
    membership, and medical management.

    • Participates in case review and medical necessity determination.
    • Conducts post service reviews issued for medical necessity and benefits determination
    coding.

    • Analyzes aggregate data and reports to primary care physician.
    • Serves as the liaison between physicians and health plan Medical Directors.
    • Supervises the functions of Care Coordination.
    • Assesses the effectiveness of the specialty network to ensure members have access to multi-specialties within their demographic area.
    • Represents the providers as an influence to the credentialing committee.
    • Reviews policies and procedures of credentialing department and offers guidance for revision
    and implementation of process.

    • Educates primary care network and assists in problem resolution.
    • Assists in development of medical management protocols.
    • Performs analysis of utilization data and suggests/implements corrective action plans with
    network physicians.

    • Performs all other related duties as assigned.
    Customer Service

    • Oversees and insures physician compliance with UM plan.
    • Evaluates performance of physicians in regards to established goals and objectives of the
    company.

    JOB DESCRIPTION
    The information listed above is not comprehensive of all duties/responsibilities performed.
    This job description is not an employment agreement or contract. Management has the
    exclusive right to alter this job description at any time without notice.

    • Performs all duties with physicians and medical group staff in a professional and responsible
    manner.

    • Responds to physicians in a prompt, pleasant and professional manner.
    • Respects physician, patient, and organizational confidentiality.
    • Educates medical groups regarding UM policies, procedures and government-mandated
    regulations.

    • Provides quality assurance and education of current medical technologies, review criteria,
    accepted practice of medicine guidelines, and UM policies and procedures with counsel
    when criterion are not met.
    Personal and Physician Development

    • Strives to personally expand working knowledge of all aspects of the UM department.
    • An active participant in physician meetings.
    • Orients new physicians to ensure understanding of company policy and resources available
    for physician support.

    • Encourages teamwork and cooperation with medical group staffs in order to prepare for cross
    training and float positions.

    • Assists in the growth and development of subordinates by sharing special knowledge with
    others and promotes continued education classes.

    • Attends continuing education classes to keep abreast of medical advancements and
    innovative practice guidelines.
    Minimum Required Education, Experience & Skills

    • Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree required.
    • Board Certified Family Practitioner or Internal Medical Specialist required.
    • Unrestricted licensed in Texas, Florida, Georgia, or New Jersey required.
    • Five or more years of clinical practice experience required.
    • Two or more years of experience in utilization management activities required.
    • Proficiency with Microsoft Office applications required.
    Preferred Education, Experience & Skills

    • Two years of experience with acute admission experience preferred.
    • Two years of experience working in a managed care health plan environment preferred.
    • Unrestricted license in New Mexico preferred (in addition to above).
    • Bilingual (English/Spanish) fluency preferred.
    What are the hours? ( Training hours?) 8am-5pm central, Mon-Fri with some weekends
    Will you be interviewing (face to face or phone) Yes interviewing via phone/webcam
    Please confirm the worksite location - (is this remote? Can they live anywhere in the USA?) Remote – can live anywhere in the US but must have the required state specific medical licensure
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