WhitePlainsRecruiter Since 2001
the smart solution for White Plains jobs

Senior Administrative Medical Director Utilization Management (Physici

Company: Optum
Location: White Plains
Posted on: September 12, 2020

Job Description:

The OrthoNet Senior Administrative Medical Director, UM provides leadership, organization, and direction for all utilization management programs and other Medical Services Department activities as applicable. Responsible for the overall quality, effectiveness and coordination of the utilization management programs and other managed care services provided through OrthoNet/Optum.

Oversees the Utilization Management program and associated Medical Directors for the company/business unit, will supervise the monitoring of utilization management and all other applicable managed care health services activities. This role provides direction and assists in the development and implementation of clinical and administrative policies and procedures and any needed clinical criteria for all medical programs and services that are part of the Company's programs. He/she will serve as the primary liaison between OrthoNet and client Medical Directors; and OrthoNet and other medical service providers with whom we interact with for health services and managed care programs.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges

Utilization Management, Health Services Delivery and other Managed Care Programs

  • Lead physician for OrthoNet's Utilization Management programs. Coordinates activities of OrthoNet physicians and MD consultants assigned to Utilization Management activities.
  • Leads efforts to ensure consistency of clinical decision-making, assures all MDs are aware of current client and OrthoNet clinical criteria, assures high quality peer-to-peer coverage and content of discussions, coordinates on staff schedules and aids in recruitment and professional development as appropriate to OrthoNet roles
  • Serves as, directed by the Chief Medical Officer or Chief Executive Officer, on various internal and/or external Committees and in other such capacities
  • Monitors all relevant reports, information summaries, clinical and financial data relating to these activities and works with senior management to further improve overall company performance
  • Provides direction for development and implementation of new utilization management, population health, provider and member integrated health care operations and other activities
  • Participates in the development and implementation of policies and procedures to ensure effective monitoring and management of managed care activities Participation in Training regarding URAC, NCQA, CMS and other Regulatory Compliance. Represents OrthoNet in broader company activities and program development as required. Provides consultative guidance, as needed, for programs in payment integrity and professional/other services claim coding. Chairs/Serves on utilization managementMedical Services and Provider Services
    • Assists the Provider Relations, customer service and other staff with resolving provider and payor issues including, but not limited to clinical inquiries, claims issues, fee schedule concerns, medical policies, procedures and member/provider appeal coordination
    • Through the Manager, UM/ Administrative Operations, oversees the non-clinical support operations of the Medical Services DepartmentLiaison Activities
      • Maintains liaison relationships with payors and providers in the community as required
      • Serves as the primary physician contact with clients/managed care clients and participating providers regarding OrthoNet [UM related] activities
      • Represents OrthoNet as required in other company businessRegulatory Requirements
        • Monitors compliance with regulatory agency standards and requirements (i.e. CMS, NCQA,URAC, state/federal and third party payors)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.


          Required Qualifications:
          • M.D. or D.O. degree
          • Current and active Unrestricted, Medical license(s) in US state(s)
          • Board certification required in ABMS-recognized specialty
          • Minimum of 5 years' post-graduate experience in clinical medical practice/patient care
          • Minimum of 2 years' experience managing professional staff and leading teams of physicians
          • Minimum of 2 years' experience in a managed care environment; to include quality improvement, utilization management and case management experience
          • Must possess leadership skills in working with other physicians and non-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.
          • Strong abilities and experience in large size health care organizations that are geographically widely distributed and heavily virtual ("remote workers")
          • Demonstrated ability in developing and internally marketing concepts for program improvement and program development.
          • Ability and experience in relating to individuals at many levels of large organizations.
          • Experience in presenting/selling programs to potential clients.
          • Specific familiarity with managed care accreditation activities and NCQA, URAC, CMS, state and other federal regulations.
          • MS Office (MS Word, Excel, and Power Point) Preferred Qualifications:
            • Certifications: ABMS specialty preferably with musculoskeletal/orthopedic emphasis
            • MBA *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.

              Keywords: Medical Director, Utilization Management, Telecommuter, ABNS, Case Management, Quality

              Keyphrases: health administration jobs, medical director jobs, hospital administration jobs, hospital administrative jobs, healthcare administration jobs, administration jobs, healthcare administrator jobs, medical administration jobs, chief medical officer jobs, medical director position jobs, associate medical director jobs, medical administrative jobs, healthcare ceo jobs, medical ceo jobs, executive director jobs

Keywords: Optum, White Plains , Senior Administrative Medical Director Utilization Management (Physici, Administration, Clerical , White Plains, New York

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Administration, Clerical Jobs


Client Care Receptionist - Aesthetic Services
Description: Ideal Image is North America's 1 Skin, Face and Body MedSpa for non-invasive aesthetic services that help you look and feel your best.-- Our goal is to help our clients achieve life changing results, (more...)
Company: Ideal Image
Location: Stamford
Posted on: 09/27/2020

Veeva Vault Admin
Description: Role - Veeva Vault AdminExperience - 3 years- Candidate should have at least 2 year of experience in supporting Veeva Vault application.- Prefer candidates
Company: IT TrailBlazers
Location: Summit
Posted on: 09/27/2020

Data Entry Specialist
Description: Job Description: -- Prepares source data for computer entry by compiling and sorting information establishing entry priorities. Processes employee questions by reviewing data for deficiencies resolving (more...)
Company: Staffing the Universe
Location: East Brunswick
Posted on: 09/27/2020


Pega Solution Architect & Pega Admin
Description: Job Description TITLE: PEGA SOLUTION ARCHITECT LOCATION:
Company: Bey
Location: Woodmere
Posted on: 09/27/2020

Salon Receptionist
Description: Drybar is a blowdry-only bar and our philosophy is simple. Focus on one thing and be the best at it. For us that's blowouts. In fact, our tagline says it all: No cuts. No color. Just blowouts.--We are (more...)
Company: drybar
Location: Hoboken
Posted on: 09/27/2020

Office Representative - State Farm Agent Team Member
Description: Position OverviewSuccessful State Farm Agent is seeking a qualified professional to join their winning team for the role of Office Representative - State Farm Agent Team Member Bilingual Spanish . We (more...)
Company: Alan Wheeler - State Farm Agent
Location: Brooklyn
Posted on: 09/27/2020

Entry Level Data Entry Position
Description: Scientia Diagnostics LLC has an immediate Full Time position for Insurance Verification and Compliance Specialist Specimen Accessioner for a Toxicology Lab in Bergen County NJ. Must have experience (more...)
Company: GENE TOX WORLDWIDE LLC
Location: Lyndhurst
Posted on: 09/27/2020

Work for the Best at Home Office
Description: Leading Health Care and Dental Benefits Discount Company is seeking Health Representatives that
Company: Living Healthy
Location: Rego Park
Posted on: 09/28/2020

Administrative Assistant / Data Entry Clerk (Remote Work From Home)
Description: You must apply on our website only.www.tnjdirect.comWe are seeking individuals to be connected
Company: JobConversion
Location: Jersey City
Posted on: 09/27/2020

Data Entry
Description: Are you a talented and motivated individual looking for a new interesting challenge or new opportunity We're on the lookout for new representatives in the local and surrounding areas To be a part of (more...)
Company: Coanainc
Location: New York
Posted on: 09/27/2020

Log In or Create An Account

Get the latest New York jobs by following @recnetNY on Twitter!

White Plains RSS job feeds