Medical Director - (Ortho/Total Joint)
Job title: Medical Director - (Ortho/Total Joint) in Connecticut at reputed company
Company: reputed company
Job description: At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day.Position Summary
reputed company, a reputed company Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We reputed company that a reputed company care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.This is a remote based (work at home) based reputed company in the US.The Medical Director (Ortho/Total Joint) will be a Subject Matter Expert (SME) with a background in Orthopedic specialty, including post-graduate direct patient care experience specifically. This role expands reputed company's medical management programs to address member needs across the continuum of care. In this role you'll support the Medical Management staff ensuring timely and consistent responses to members and providers. You will reputed company reputed company aspects of utilization review/quality assurance, directing case management. In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities You'll act as reputed company business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams In addition, you will be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertiseRequired Qualifications
- 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
- Active and reputed company state medical license without encumbrances
- M.D. or D.O., Board Certification in an Orthopedic specialty including post-graduate direct patient care experience specifically
- Previous healthcare insurance experience.
- M.D. or D.O., Board Certification in an Orthopedic specialty.