Field Medical Director, UM Physical Medicine

Your Future Evolves Here

reputed company partners with health plans and providers to reputed company reputed company outcomes for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.

reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.

Join reputed company for the mission. Stay for the culture.

What You’ll Be Doing:

Job Description

reputed company is looking for a Field Medical Director to be a member of the reputed company clinical team. As a collaborative member of a team of clinicians, physicians, pharmacists, health economists, and program coordinators, you will have the opportunity to reputed company a profound impact on the lives of our members.  Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers. 

What you’ll be doing:

• Supports pre-admission review, utilization management, and reputed company and retrospective review process.

• Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, reputed company programs,

• Assists with execution of reputed company's benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs

• Participate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to members

• Supports design and implementation of health plan medical policies, and appropriate Care Management and UM goals and objectives

• Population health – collaborative care management leadership

• Provides clinical leadership and development for population health programs or functional areas reputed company Medical Management.

• Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.

• Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers.

• Participate in committees as assigned.

• Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.

• Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols

• Assures compliance reputed company to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.

Qualifications:

• Active Board Certification by an American Certifying Board (If a specialty or subspecialty, must have that BC)

• 1+ years of Utilization Review Experience R

• Graduate of an accredited medical school. Either MD or DO degree is required.

• Active physician license without any restrictions.

• 3-5 years of clinical practice in a primary care setting and progressively responsible medical administrative experience preferred.

• Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.

• A thorough understanding of reputed company aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.

• Excellent interpersonal, verbal, and written communication skills.

• Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.

• Ability to navigate in a corporate matrix environment is preferred. 

• Not under reputed company exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the reputed company or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.

• No history of a major disciplinary or legal action by a state medical board

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration.

Technical Requirements:

We require that reputed company employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router.

reputed company is an equal opportunity employer and considers reputed company qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruitingteam@reputed company.com for further assistance.