Administrative Physician - Physicians Only Apply - Perm
Company: UnitedHealth Group
Location: White Plains
Posted on: September 22, 2024
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Job Description:
A Administrative Physician practice is seeking a qualified
physician for White Plains, NY. This and other physician jobs
brought to you by ExactMD. Medical Doctors Only Apply.
OrthoNet - Senior Medical Director, Payment Integrity - White
Plains, NY
Position Description
You're looking for something bigger for your career. How about
inventing the future of health care? We're pushing ourselves and
each other to find smarter solutions. The result is a culture of
performance that's driving the health care industry forward. As a
Medical Director you will use your talents to take our
already-exceptional service and innovation to the next level. You
will lead a team of world-class professionals who are removing
barriers to better health with every new idea. Ready for a new
path? Join us and start doing your life's best work.(sm)
The Medical Director provides leadership, organization, and
direction for all medical management programs and services.
Responsible for the overall quality, effectiveness and coordination
of the medical services provided through OrthoNet. Directs the
Utilization Management, and Quality Improvement programs for the
company. The Medical Director will participate in the monitoring of
care administration and medical decision making and coordinates
provider appeals. He/she may assist the Provider Services staff in
all matters involving provider credentialing, issues and
relationships. The Medical Director also provides direction and
oversight in the development and implementation of policies and
procedures and clinical criteria for all medical programs and
services. They will serve as the primary liaison between OrthoNet,
physicians, and other medical service providers.
Primary Responsibilities:
Payment Integrity
---Lead physician for OrthoNet---s growing family of payment
integrity (Focused Claims Review) programs including professional
and other health care claim reviews. Coordinates activities of the
several teams of OrthoNet physicians and consultants that work in
this area
---Expertise with professional procedure coding, claim reviews and
appeal activity. Skilled at providing explanations of adverse
decisions made on claims
---Strong interest in fraud and abuse detection and prevention
Utilization Management
---Assists in required in aspects of the utilization management,
quality & improvement activities and monitors all reports,
information summaries, clinical and financial data relating to
these activities
---Designs and helps to implement programs to help ensure that all
participating providers deliver quality, cost effective care across
all settings
---Assists in the development and implementation of policies and
procedures to ensure effective monitoring and management of
clinical interventions
---Participation in Training regarding URAC, NCQA, Regulatory
Compliance, Confidentiality, Conflict of Interest, HIPAA, and
department specific training as applicable
Committee and Leadership Responsibilities
---As directed by the Chief Medical Officer leads committees and
other work groups to accomplish the key quality improvement and
utilization management objectives of OrthoNet
---Serves as, directed by the Chief Medical Officer, on various
internal and/or external Committees and in other such
capacities
---Serves as lead day-to-day clinician for the coordination of
physicians working on payment integrity activities. Leads efforts
to ensure consistency of clinical decision making, assures all MDs
are aware of current development in client and OrthoNet clinical
criteria, assures high quality peer-to-peer coverage and content of
discussions, coordinates on call schedules and aids in recruitment
and professional development as appropriate to OrthoNet roles
Network Services
---Supports the credentialing activities required for physician and
other clinical employees and consultants
---Assists 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
Liaison Activities
---Assists with liaison relationships with payors and providers in
the community as needed
---Serves as lead contact with participating provider regarding
payment integrity services with OrthoNet activities. Supports other
OrthoNet medical directors and staff with broader client,
professional, regulatory and community liaison
Regulatory Requirements
---Supports compliance with regulatory agency standards and
requirements (i.e. HCFA, NCQA, URAC, state/federal and third party
payors)
---Perform all other duties as assigned
Requirements
To be considered for this position, applicants need to meet the
qualifications listed in this posting.
Required Qualifications:
---Current and active Unrestricted, Medical license
---M.D. or D.O. degree
---Active Board certification required in ABMS-recognized
specialty
---Minimum five years previous experience in a progressive,
results-oriented managed care environment, quality improvement, and
utilization management and case management experiences strongly
preferred
---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
---Excellent verbal and written communication skills
---Diplomacy and tact in dealing with sensitive issues
---Must possess leadership skills in working with other physicians,
knowledge of the overall medical community and the local/regional
managed care environments
---Strong analytical problem solving and decision-making skills
---Familiarity with managed care accreditation activities and NCQA,
URAC and state and federal regulations
---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
---Knowledge in the principles and practice of broad cardiovascular
clinical practice desired
---Broad clinical interests and working knowledge of current
clinical practices and major national trends in health care
service
---Broad understanding of fraud and abuse
---Understanding of coding issues as it pertains to fraud and
abuse
---Experience in appeals and grievances in a managed care
environment
---Proficient computer skills
---Post-graduate experience in medical practice/patient care is
essential
---Leadership positions and academic experiences are of value
---Special interest and experience in payment integrity issues are
of key interest
UnitedHealth Group is working to create the health care system of
tomorrow.
Already Fortune 14, we are totally focused on innovation and
change. We work a little harder. We aim a little higher. We expect
more from ourselves and each other. And at the end of the day,
we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals,
we're building a high-performance health care system that works
better for more people in more ways than ever. Now we're looking to
reinforce our team with people who are decisive, brilliant - and
built for speed.
Come to UnitedHealth Group, and share your ideas and your passion
for doing more. We have roles that will fit your skills and
knowledge. We have diverse opportunities that will fit your
dreams.
Diversity creates a healthier atmosphere: 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: UnitedHealth Group, White Plains , Administrative Physician - Physicians Only Apply - Perm, Administration, Clerical , White Plains, New York
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