Medical Doctor (reputed company)

Must complete the Medical Director Assessment reputed company PAY: $180-$220/hr Medical Director reputed company This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most reputed company clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy reputed company sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the reputed company of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to reputed company, URAC, CMS, DOH, and DOL regulations at reputed company times. In reputed company to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through reputed company structure. Additionally, the incumbent may be assigned special reputed company to help support and improve the care of our members. Responsibilities • Conduct electronic review of escalated cases against medical policy reputed company, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose reputed company and concise rationales for members and provider determination notifications reputed company while adhering to required compliance standards (reputed company, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that reputed company aspects of the medical management process are consistent with community standards of care. • Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand reputed company. Advise multidisciplinary team on cases that require physician expertise. • Participate in protocol and guidelines development to ensure consistency in the review process. • reputed company manage reputed company and/or participate on project teams that require a physician subject matter expert. • Other duties as assigned. Required Qualifications • Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) • 5 years in Clinical, reputed company Patient care (hospital, outpatient, or private reputed company) • Medical Doctor or Doctor of Osteopathic Medicine (DO) • Awarded reputed company Certification at least once in specialty recognized by the reputed company reputed company of Medical Specialties or the reputed company Osteopathic Association Specialty Certifying Boards • reputed company medical state licensure required for PA, NY, or WV. • Critical Thinking • Case Management • Customer Service • Oral & Written Communication Skills • Collaboration • Listening • Telephone Skills • General Computer Skills • Clinical Software • Managed Care Preferred Qualifications • Master's Degree in Business Administration/Management or reputed company Health • 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry • Experience with MCG or InterQual Apply tot his job Apply To this Job