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Lead Medical Director, Pain Management - Telecommute

Company: UnitedHealth Group
Location: White Plains
Posted on: February 8, 2019

Job Description:

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Clinical Services is focused on driving measurable and meaningful improvement in the use of evidence - based medicine, patient safety, practice variation and affordability. In serving our Medicare, Medicaid, and commercial members & plan sponsors, our Clinical Services teams partner with our network of physicians, hospitals and other health care professionals to achieve these goals. We are committed to our mission of helping people live healthier lives and inspire--your life's best work. (sm)

The Lead Medical Director provides leadership, organization, and direction for aspects of the Utilization Management programs and services.-- Responsible, in part, 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 particiates in the Quality Improvement programs for the company.
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The Lead Medical Director will participate in the monitoring of patient care progress, treating physician medical decision making in the context of utilization management and coordinates provider appeals.-- He/she may assist the Provider Services staff in all matters involving provider credentialing, issues and relationships.----
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The Lead Medical Director also provides/assists 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.------
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Primary Responsibilities:


  • Is administrative and clinical leader for the Pain Management medical team
  • Performs utilization management reviews for interventional pain management procedures and related services (pre-certification, concurrent review and retrospective reviews including appeals--)
  • Works with OrthoNet 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 payors)
  • 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 enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

    Required Qualifications:

    • Current, active and fully unrestricted Medical (MD or DO) license.
    • Post Graduate Specialty Training.----ABMS or other nationally-recognized further specialized certifications are a plus.
    • 5+ years clinical experience in relevant pain management clinical specialty, post residency.---- --
      Preferred Qualifications:

      • Experience in managed care UM activities. Prior experience with pre-certification and professional claim coding / claim coding reviews desired
      • 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
      • 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
      • Proficient computer skills and ability to learn to use OrthoNet clinical and claims software
      • Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel.
      • MS Office (MS Word, Excel, and Power Point)
        Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.(sm)

        Employer is working to create the health care system of tomorrow.

        Already Fortune 6, 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 Employer, 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.


        *All Telecommuters will be required to adhere to Employer's Telecommuter Policy


        Diversity creates a healthier atmosphere: Employer 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.



        Employer is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.




        Job Keywords:--Physician, MD, Medical Director, Clinical, quality management,--utilization management, utilization review--

        Keywords: UnitedHealth Group, White Plains , Lead Medical Director, Pain Management - Telecommute, Executive , White Plains, New York

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