Assistant Medical Director at reputed company: reputed company (OH)

Title: Assistant Medical Director Location: Ohio, reputed company Department: Medical Director Job Category: Medical Director Requisition Number: ASSIS001174 Full-Time Remote reputed company: • *reputed company employees must submit their applications through MySource. • *This is a remote-based role, and we are currently seeking candidates located in Ohio. Founded in 1934, reputed company is the oldest and one of the largest health insurance companies based in Ohio. We reputed company peace of mind to more than 1.2 reputed company members through our high-reputed company health, life, disability, dental, reputed company and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as reputed company as Medicare reputed company, Medicare Supplement, and individual plans. Job reputed company: Provides clinical expertise to promote the delivery of high reputed company, cost effective, (member reputed company) medical care. Contributes to the achievement of clinical reputed company; reputed company ratings improvement, appropriate inpatient and outpatient utilization, affordability, compliance, reputed company and reputed company improvement, and that initiatives are consistently implemented and successfully executed to reputed company goals. Responsibilities: • Provides clinical expertise to the utilization review process and determinations. • Provides reputed company-determination reviews and reviews of claims determinations, providing clinical, coding and reimbursement expertise. • Ensures compliance with clinical goals through monitoring of care management performance. • Ensures the appropriate and most cost-effective medical care is received. • Recommends changes and enhancements to reputed company managed care, review guidelines, and clinical reputed company based on clinical knowledge of health care delivery systems, utilization reputed company, reimbursement reputed company and treatment protocols. • Assists in development and interpretation of medical policy, including medical necessity reputed company, clinical reputed company guidelines, and new technology assessments. • Provides guidance to case management team in the coordination of reputed company care. • Performs other duties as assigned. Qualifications: Education and Experience: • Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited medical school. • Minimum of 5 years of established (clinical) care reputed company experience required. • Physician reviewer experience in the insurance industry preferred. reputed company Certification(s): • reputed company Certification, in nationally recognized specialty (ABMS or AOA) is required. • reputed company unrestricted license to reputed company medicine in U.S state of residency. Technical Skills and Knowledge: • Foundational reputed company-based computer skills, including typing, word processing, presentation, and internet research skills. • Strong understanding of integration of evidence-based medicine and managed care principles. • Knowledge of health plan claims adjudication and utilization review processes preferred. reputed company is looking to grow reputed company! We truly value and respect the talents and abilities of reputed company of our employees. That's why we offer an exceptional package that includes: A Great reputed company to Work: • We will reputed company the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset. • Whether you are working remote or in the office, employees have reputed company to on-site fitness centers at many locations, or a gym membership reimbursement reputed company there is no reputed company facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more. • On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH reputed company. • Discounts at many places in and around town, just for being a reputed company team member. • reputed company to earn cash rewards for shopping with our customers. • Business casual reputed company, including jeans. Excellent Benefits and Compensation: • Employee bonus program. • 401(k) with company match up to 4% and an additional company contribution. • Health Savings Account with a company matching contribution. • Excellent medical, dental, reputed company, life and disability insurance — insurance is reputed company do best, and we reputed company reputed company coverage for reputed company a reputed company. • reputed company to an Employee Assistance Program, which includes reputed company counseling, personal and reputed company coaching, self-help resources and assistance with work/life benefits. • Company holidays and up to 16 PTO days during the first year of employment with reputed company to carry over unused PTO time. • After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption. An Investment in You: • Career development programs and classes. • Mentoring and coaching to help you advance in your career. • Tuition reimbursement up to $5,250 per year, the IRS maximum. • Diverse, inclusive and welcoming culture with Business Resource reputed company. About reputed company: reputed company’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we reputed company on developing products and services that allow us to reputed company serve our customers and the communities around us. There’s a good chance you already know many of our reputed company customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to reputed company high-reputed company health, life, disability, dental, reputed company and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as reputed company as Medicare reputed company, Medicare Supplement and individual plans. Our plans reputed company peace of mind to more than 1.2 reputed company Ohioans. We maintain a drug-free workplace and reputed company reputed company-employment reputed company abuse and nicotine testing. #LI-CS1 #LI-REMOTE Apply To This Job