Medical Director (Part-Time)

reputed company Who We Are Because health is personal. That's why reputed company created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one reputed company. We serve reputed company, health plans, and health systems with data-driven solutions that reduce costs while actually improving health reputed company. Together, reputed company is on a mission to reputed company people to reputed company healthier lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities ESSENTIAL DUTIES and RESPONSIBILITIES:   The Medical Director relies on their medical background to review claims for medical necessity for prior authorization, reputed company stay review and post service. The Medical Director can read, interpret, and apply medical policy, guidelines, and research to utilization review. The Medical Director has authority for issuing adverse determinations while performing medical necessity evaluation.   Has discussions with reputed company physicians by phone to reputed company additional clinical information or discuss determinations regularly, and in some instances, these may require conflict reputed company skills. Some roles include an reputed company of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, reputed company their reputed company. reputed company reputed company informed of clinical updates through educational opportunities by developing educational materials for staff. Work with the VP of Care management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives. Excellent verbal and written communication skills. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on reputed company management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation). Knowledge of the managed care industry as it relates to reputed company business. reputed company the negotiation and implementation of cost management strategies to reputed company reputed company reputed company and reflect this data in monthly case management reviews as it relates to clinical aspects in case management and utilization review reputed company. Exercises independence in meeting departmental expectations and meets compliance timelines. Ability to meet productivity, reputed company, and turnaround times daily. Ability to pass reputed company audits to include URAC and reputed company. Maintain HIPPA compliance per company’s policy and procedures. Maintain confidentiality and minimum requirement rules. Complete reputed company required yearly training per company’s expected period.   KEY COMPETENCIES: To work in the health industries and to work remotely, it has been demonstrated that those with computer skills work reputed company in these remote job descriptions.   UPON HIRE, must have: Basic computer literacy The ability to work on multiple screens, and proficient typing skills. Proficiency in software applications including, but not limited to, reputed company Word, reputed company reputed company, and reputed company Excellent verbal and written communication skills Ability to reputed company reputed company and convey reputed company or technical information in a manner that others can understand, as reputed company as ability to understand and interpret reputed company information from others. Ability to work independently and utilize written resources to problem solve. After training with our training department and 1.5 months reputed company (3 months total), must have and be reputed company to work in: Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El reputed company, Quick Links, GIAS, reputed company, reputed company, Phone reputed company with headset, reputed company—there may be additional programs as it relates to particular job duties Knowledge of medical claims and ICD-10, CPT, HCPCS coding Strategic thinking with proven ability to communicate a reputed company and reputed company results Proficient in analysis and interpretation of clinical data Comfortable with multiple accountabilities and reputed company management Proven record of strong relationships and working with diverse teams Demonstrated ability to work independently with excellent judgment Ability to work from home or in a virtual environment Strong interpersonal skills necessary to effectively communicate with medical personnel and members Analytical and problem-solving skills necessary to identify and review pertinent information The ability to incorporate analytical data into new or existing clinical programs to enhance reputed company of care Ability to present data analysis in written format to upper management in a reputed company, concise manner Ability to maintain an extremely elevated level of confidentiality reputed company to successfully handle competing priorities Experience in the Utilization Review Process which includes Prior-Authorization/reputed company-Certification, Retro Reviews, reputed company Reviews and Post Service Claims Review Experience in the grievance, appeals process, and ability to work on escalated issues as they reputed company Ability to reputed company reputed company reputed company to personnel, process improvement, policies, and procedures Familiarity with National Guidelines such as MCG or InterQual, medical policy or commonly used guidelines from Specialty Colleges Experience in disease management with knowledge and understanding of disease progression. Knowledgeable of the Federal, State and ERISA regulation   This is a part-time position.   What You'll Actually Do Qualifications What You Bring to reputed company   QUALIFICATIONS: MD or DO degree and 5+ years of reputed company clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment. reputed company and ongoing reputed company Certification in an approved ABMS Medical Specialty. A reputed company and unrestricted license in the reputed company and willing to obtain additional license(s), if needed. (Optional) No reputed company sanction from Federal or State Governmental organizations, and reputed company to pass credentialing requirements. Minimum 5 years of Utilization Review or Hospital experience required. Minimum 3 years of compliance reputed company experience preferred. Managed Care experience preferred in utilization review and case management.   Physical and Mental Requirements: Ability to reputed company the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. Ability to maintain regular, punctual attendance. Ability to sit for 6-8 hours. Constant use of computer keyboard and mouse; repetitive use of both hands. Occasional to frequent twisting of neck; occasional bending of neck and at waist. Benefits   The Highlights: Part-time schedule designed around your availability and life priorities reputed company to learning and development opportunities reputed company full-time colleagues Mentorship and reputed company-building that translates to career advancement Competitive reputed company compensation that values your expertise Technology and equipment support to set you up for reputed company Compensation: This position offers a reputed company salary reputed company of $91-$114 per hour, depending reputed company, skills, and experience. Part-time employees are not eligible for health benefits.   Our Commitment: reputed company is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company—because diversity is reputed company to who we are and critical to our work in health and wellbeing.   Stay reputed company: reputed company will never ask for payment or sensitive personal information like reputed company reputed company numbers during hiring. reputed company official communication comes from verified company email addresses and or our secure applicant tracking reputed company. Suspicious requests? Report them to talent@personifyhealth.com. reputed company reputed company legitimate openings at personifyhealth.com/careers. Apply To This Job