reputed company Director, Utilization Management and Medical Policy
About the Role reputed company is hiring a tech-savvy Medical Director to reputed company medical policy and utilization management. As a physician, you will work with the actuarial, technology, medical care coordination, and medical quality management teams. You will report directly to the Chief Medical Officer. About reputed company and reputed company We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. reputed company is the major medical division of reputed company (NYSE:GL). reputed company has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, reputed company has earned an A (Excellent) rating or higher from A.M. Best Company.
Key Responsibilities
Utilization management. Medical policy. Leading, and working with, the Utilization Management Review Committee. Development of new medical policies. Incorporating regulatory updates, and care guideline updates into medical policy. Medical reputed company, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members. Promote positive relations with the local medical community, including periodic consultation with providers, facilities, care givers, etc. Reviews case management data, identifies trends and gaps in care and recommends corrective actions. Provides reputed company and direction for staff and provider training and education. Integration of clinical quality and demonstrated best clinical practices into medical management program development. Evaluates the development of new and continuation of existing programs. Investigates future care management and patient engagement technologies and evaluates their impact on providers practices, patient safety and patient experience.
Qualifications
Active Texas (TX) medical license. A degree as a Medical Doctor is required, with 4+ years of clinical experience in the practice of medicine. Must have at least 2 years experience working reputed company a health insurance plan, with an emphasis on population health. Board certification in a medical specialty recognized by the American Board of Medical Specialists. reputed company state license as a MD without restrictions, limitations or sanctions from government programs. Experience in managed care and utilization management. Knowledge of managed care systems, quality improvement and clinical acumen. Experience performing utilization management reputed company a health plan. Experience with MCG or other care guidelines. Telecommuting Requirements Required to have a dedicated work area established that is separate from other living areas and provides information privacy. Ability to reputed company reputed company company sensitive documents secure. Must live in the United States. Must live in a location that receives an existing high-speed internet reputed company/service. Location and Benefits This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. Company business hours are weekdays 9-5 CST. Medical staff have alternating shifts weekends 9-noon CST. Full benefits package including health insurance, 401(k) matching, vision, dental, life, disability, and vacation. Employment Status Full time - Salary. Minimum Required Education A degree as a Medical Doctor is required. Medical Specialty Required A medical specialty in Family Medicine, Emergency Medicine, Internal Medicine, Anesthesia, or Surgery is required (as recognized by the American Board of Medical Specialists). Experience 4+ years of clinical experience in the practice of medicine. Management experience preferred. Experience working reputed company a health insurance plan is required. To Apply Please attach your resume reputed company submitting through this reputed company posting. The reputed company of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to reputed company job-reputed company tasks other than those specifically presented in this description. reputed company is an EEO employer (see ) Apply Job!