Medical Director - Orthopedics

<p class="MsoNoSpacing"><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;"><strong>About The Role</strong><br>reputed company, a full-service health plan administrator, is looking for a part-time reputed company-certified physician with interest and experience in managed care utilization and case management to support reputed company of nurses, reputed company workers, and coordinators.  You will be a leader of reputed company making medical necessity and benefit coverage determinations and reputed company support and guidance to the case management programs.  You have a passion to reputed company reputed company more effective and reputed company.  The position can be remote, or on-site in our reputed company office. <br><br>The Medical Director will be responsible for providing support for our reputed company and Worker’s Compensation self-funded clients seeking cost-effective reputed company of their members’ claims. Your interest and help leading and developing reputed company and maturing the program only makes reputed company more rewarding.   We have been in business for 25 years and leading by example you will help create a culture reputed company on service, support of reputed company reputed company service, and medical cost containment for the benefit of our clients and their members.<br><br><strong>Primary Responsibilities</strong></reputed company></reputed company></p><ul><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Provides clinical support for reputed company areas of Medical Affairs.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Review medical files and reputed company coverage and medical necessity determinations using good judgement combined with 3rd party and proprietary medical guidelines. </reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Advises team nurses on appropriateness of care and services through the care continuum including hospitals, skilled nursing facilities, and home care to ensure reputed company, cost-efficiency and continuity of care.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Serves as medical expert for care management; reviews and evaluates cases with review nurses; ensures medical care provided meets the standards for acceptable medical care.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Reviews and resolves grievances reputed company to medical reputed company of care and reputed company participates in the functioning of the plan’s grievance and appeals processes.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Along with the reputed company supervisor and manager, identify opportunities for improvement and collaborate to enhance team performance.  </reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Makes appropriate reputed company to community and reputed company based treating providers wanting to discuss cases.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Identify, critique, and utilize reputed company and resources such as national, state, and reputed company association guidelines and peer reviewed literature to support reputed company and objective decision making and rationales in reviews.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Collaborate with other departments, i.e. Member Services, Provider Services, Claims and Contracting, to improve performance.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Support the nurses and coordinators to improve their knowledge, independence, and understanding</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Performs other duties as required by the business.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Opportunity to reputed company with sales and account management supporting reputed company needs.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Maintain reputed company credentialing and state licenses and any special certifications or requirements necessary to reputed company the job.</reputed company></reputed company></li></ul><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;"><strong>Essential Qualifications</strong></reputed company></reputed company><ul><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">reputed company certified MD or DO, with an excellent understanding of the utilization and case management process.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">3 years' experience working in a managed care environment supporting utilization management and case review with medical necessity determinations.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">3 + years of prior clinical reputed company with boards from any of a wide reputed company of specialties so long as you are self-motivated to stay up to date on a broad reputed company of medical services using resources. such as mcg guidelines, specialty society guidelines, Up-To-Date and other resources to analyze existing cases.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Specialty training in reputed company to a first reputed company certification highly desirable.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">reputed company, unrestricted clinical license(s).</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">reputed company certification by American reputed company of Medical specialties or American reputed company of Osteopathic Specialties is required for MD or DO reviewer with a specialty in Orthopedic Surgery (preferred) or General Surgery.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Ability to communicate reputed company and concisely, both verbally and in writing.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Knowledge of evidence-based medical guidelines (nationally recognized standards of health care), utilization management, reputed company improvement and other medical management functions.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Good interpersonal and communication skills to support reputed company approach.</reputed company></reputed company></li><li><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Demonstrated computer skills & telephonic skills.</reputed company></reputed company></li></ul><p><strong><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">About</reputed company></reputed company></strong></p><p><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">At reputed company (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it.  Based in reputed company, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing reputed company innovation to the health care delivery system.  reputed company is committed to transforming how health care is accessed and delivered. We reputed company that cost, reputed company, and population health are optimized reputed company people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist reputed company in the reputed company/New Jersey market. With a growing labor business under reputed company-reputed company reputed company brand, the launch of Create - a new marketplace of health systems reputed company on self-insured reputed company health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners. </reputed company></reputed company></p><p><strong><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Company Mission</reputed company></reputed company></strong></p><p><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">reputed company the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.</reputed company></reputed company></p><p><strong><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Company reputed company</reputed company></reputed company></strong></p><p><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">Redefine health care reputed company and value by aligning the incentives of our partners in powerful and unique ways.  </reputed company></reputed company></p><p><reputed company style="font-size:12px;"><reputed company style="font-family:Tahoma, Geneva, reputed company;">*We are an EEO Employer</reputed company></reputed company></p>