WhitePlainsRecruiter Since 2001
the smart solution for White Plains jobs

Claims Review Medical Director Orthopedic Surgery (Physician #)

Company: Optum
Location: White Plains
Posted on: March 24, 2020

Job Description:

Orthopedics opening in White Plains, New York.
As part of the Focus Claims Review team, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness and coordination of the medical services provided through OrthoNet. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. S/he will serve as a liaison between OrthoNet, physicians, and other medical service providers in selected situations primarily related to medical claim reviews.

Primary Responsibilities:

  • Reviews surgical and other professional claims for correct coding using clinical record
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
  • Discusses cases and clinical coding 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.Required Qualifications:
    • Current, active and fully unrestricted Medical license
    • Board certified in an ABMS specialty
    • 5+ years clinical experience in Orthopedic Surgery post residency with Sub-Specialty training in Spine, Hand, Joint and/or Sport
    • Use and knowledge of coding and billing practices
    • Proficient computer skills to include MS Office (MS Word, Excel, and Power Point)
    • Ability to learn to use OrthoNet clinical and claims software
    • Must be able to work Eastern Standard Time hours Preferred Qualifications:
      • Experience in managed care
      • Prior experience with professional claim coding resources / claim coding reviews and techniques strongly preferred
      • Exhibits 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
        Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

        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: Claims, Medical Director, Telecommute, Orthopedic, Surgery

Keywords: Optum, White Plains , Claims Review Medical Director Orthopedic Surgery (Physician #), Executive , 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 Executive Jobs


Accounting Operations Senior Manager
Description: Job Description Auto req ID: 204540BR Job Description This role reports to the Sr. Director, PBC Supply Chain Accounting and Control and is primarily responsible for Inventory and Cost of Goods Sold (more...)
Company: Pepsico, Inc.
Location: White Plains
Posted on: 04/9/2020

Cybersecurity Project Manager
Description: Cybersecurity Project Manager -Contract Role in White Plains, NY Cybersecurity Project Manager for a global firm needed to join a team monitoring security tools and responding investigating alerts. The (more...)
Company: RedStream Technology LLC
Location: White Plains
Posted on: 04/9/2020

PMO Manager
Description: DIRECT CLIENT REQUIREMENT Job Title PMO Manager Location Wayne, NJ Duration 6 Months Contract ndash Hire Job description The Program Management Office PMO Manager will support the Program Director (more...)
Company: APN Consulting Inc
Location: Wayne
Posted on: 04/9/2020


Mechanical Engineering Department Manager
Description: If you are a Mechanical Engineer with passion for Design, please read on br br What You Will Be Doing br br You will be required to perform a variety of engineering tasks and will be responsible (more...)
Company: W3Global
Location: White Plains
Posted on: 04/9/2020

Shift Supervisor Management Trainee
Description: Job DescriptionThe Shift Supervisor Trainee role is an entry-level, short-term role that prepares an employee to perform a higher-level supervisory role, such as Operations Supervisor or Shift Supervisor. (more...)
Company: CVS Health
Location: West Babylon
Posted on: 04/9/2020

Shift Supervisor Management Trainee
Description: Job DescriptionThe Shift Supervisor Trainee role is an entry-level, short-term role that prepares an employee to perform a higher-level supervisory role, such as Operations Supervisor or Shift Supervisor. (more...)
Company: CVS Health
Location: Freeport
Posted on: 04/9/2020

Brand Mktg Manager - TM Pepsi
Description: Job Description Auto req ID: 206176BR Job Description Reporting to the Director of Marketing, the Marketing Manager will be responsible for leading tentpole trademark comms focused on seasonal programs (more...)
Company: Pepsico, Inc.
Location: White Plains
Posted on: 04/9/2020

Assistant Director of Public Relations
Description: Assistant Director of Public RelationsSchool/Division:Office of University RelationsOffice:Office of University RelationsFull-Time or Part-Time:Full-TimeAbout HofstraHofstra University is a nationally (more...)
Company: Hofstra University
Location: Hempstead
Posted on: 04/9/2020

Store Manager
Description: You were born to lead. Reporting to your District Manager, your number one priority is to lead the store team to provide extreme customer service. You will lead, coach, and develop your team to exceed (more...)
Company: Foot Locker
Location: Wayne
Posted on: 04/9/2020

Retail Store Manager
Description: Job DescriptionGeneral Summary: The Store Manager In Training SMIT job is the first step in the CVS/pharmacy Retail Management Development Program, and is a short-term role not to exceed 24 months (more...)
Company: CVS Health
Location: Freeport
Posted on: 04/9/2020

Log In or Create An Account

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

White Plains RSS job feeds