Utilization Management Medical Director
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Job Description
UM medical director managing health claims for Conviva Senior Primary Care. Making medical decisions and interpreting appropriateness of services provided by healthcare professionals.
Responsibilities:
- rely on medical background and review health claims
- provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards
- make decisions on moderately complex to complex issues regarding technical approach for project components
- exercise considerable latitude in determining objectives and approaches to assignments
Requirements:
- MD or DO degree
- Three years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age)
- Current and ongoing board certification an approved ABMS medical Specialty, or other board demonstrating advanced training in transitions of care, quality assurance, utilization management and care coordination
- A current and unrestricted medical license in at least one jurisdiction and willing to obtain additional license
- No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
- Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on transitions of care, quality management, utilization management, case management, discharge planning and/or home health or post-acute services such as inpatient rehabilitation.
Benefits:
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities
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