Responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services provided through OrthoNet. Performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company.
The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services. S/he may serve as a liaison between OrthoNet, physicians, and other medical service providers in selected situations.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Performs utilization management reviews for various types of musculoskeletal and other medical/surgical services which may include PT OT ST, home health care, SNF, LTAC and acute inpatient rehabilitation services.
- Works with OrthoNet clinical staff to coordinate all the necessary UM processes and provides feedback to OrthoNet staff who do portions of the UM reviews
- Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
- Discusses cases and clinical situations with treating providers telephonically during scheduled hours
- Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
- Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
- Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions
- Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third party payers)
- Ability to travel to scheduled company meetings and activities in US
- Ability to assist in marketing presentations to clients and ongoing relationship management activities with existing clients if requested to do so
- Provide Clinical support for staff that conduct initial reviews
- Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Current, active and fully unrestricted Medical license
- 5+ years clinical experience in musculoskeletal medicine and surgery
- MS Office (MS Word, Email, Excel, and Power Point)
- Excellent computer skills and ability to learn new systems and software
- Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
- ABMS or other nationally recognized further specialized certifications are a plus
- Experience in managed care UM activities
- Must possess leadership skills in working with other physicians, knowledge of the overall medical community and the local / regional managed care environments
- Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
- All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Key words: Orthopedic, Spine, Medical Director, Telecommute