WhitePlainsRecruiter Since 2001
the smart solution for White Plains jobs

Claims Review Medical Director Spine Surgery

Company: Optum
Location: White Plains
Posted on: February 16, 2020

Job Description:

Surgery-General opening in White Plains, New York. This and other physician jobs brought to you by DocCafe.com
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 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 surgery
  • 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 hoursPreferred Qualifications:
  • Experience in managed care
  • Prior experience with professional claim coding resources / claim coding reviews and techniques
  • 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.

    Job Keywords: Claims, Review, Medical Director, Spine, Surgery, White Plains, New York, NY Keyphrases: general surgery jobs, surgery jobs, surgeon jobs, general surgeon jobs, cardiovascular thoracic surgery jobs, cardiovascular thoracic surgeon jobs, thoracic cardiovascular surgery jobs, thoracic cardiovascular surgeon jobs, thoracic and cardiovascular surgeon jobs, thoracic and cardiovascular surgery jobs, colo rectal surgeon jobs, colo rectal surgery jobs, neuro surgeon jobs, neuro surgery jobs, oral plastic surgery jobs, oral plastic surgeon jobs, pediatric oral surgery jobs, pediatric oral surgeon jobs, dental oral surgery jobs, dentist oral surgeon jobs, dentist oral surgery jobs, maxillofacial oral surgeon jobs, maxillofacial oral surgery jobs, oral maxillofacial surgeon jobs, oral maxillofacial surgery jobs, cardio thoracic surgery jobs, cardio thoracic surgeon jobs, cardio vascular surgeon jobs, pediatric vascular surgeon jobs, pediatric vascular surgery jobs, surg tech jobs, surgery tech jobs, surgical tech jobs, gynecologic surgery jobs, surgical jobs

Keywords: Optum, White Plains , Claims Review Medical Director Spine Surgery, Healthcare , 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 Healthcare Jobs


Nurse Practitioner, Urgent Care
Description: Urgent Care opening in Lakewood, New Jersey. This and other physician jobs brought to you by DocCafe.com The CHEMED Health FASTTRACKdepartment has a full-time or part time opening for an experienced Family (more...)
Company: CHEMED
Location: Lakewood
Posted on: 02/21/2020

Registered Nurse - CVOR - 13 Week Contract
Description: We're hiring a skilled Registered Nurse that's experienced at caring for patients who are recovering from Cardiac Surgery, including heart and lung transplantation, for a 13 week contract at a state-of-the-art
Company: Jackson Nurse Professionals
Location: New Brunswick
Posted on: 02/21/2020

Licensed Clinical Psychologist
Description: br br Overview br br Licensed Psychologist br br White Plains, NY br br Join a leading APA-accredited, clinician-led behavioral health company today C.H.E. Behavioral Health Services (more...)
Company: CHE Behavioral Health Services
Location: White Plains
Posted on: 02/21/2020


Permanent Primary Care Physician in New Jersey
Description:
Company: Ocean Health Initiatives
Location: Lakewood
Posted on: 02/21/2020

RN Chest Pain Center Full Time (Relo - TX - Sign On Bonus)
Description: Certified Chest Pain Center/Acute Medical Unit STC-2 Full-Time - 36 Hours/Week Baylor Scott White Health is the largest not-for-profit health care system in the state of Texas. With total assets of (more...)
Company: Baylor Scott
Location: Mount Vernon
Posted on: 02/21/2020

OB/GYN Physician
Description: Obstetrics Gynecology opening in Lakewood, New Jersey. This and other physician jobs brought to you by DocCafe.com CHEMED Health, a bustling health center located near the scenic Jersey Shore, we are (more...)
Company: CHEMED
Location: Lakewood
Posted on: 02/21/2020

Pediatric Nurse Practitioner (Behavioral Health)
Description: Psychiatric-Mental Health opening in Lakewood, New Jersey. This and other physician assistant jobs brought to you by DocCafe.com We are looking for a Behavioral Health Pediatric Nurse Practitioner to (more...)
Company: CHEMED
Location: Lakewood
Posted on: 02/21/2020

RN Renal Transplant Acute Care $8,000 sign on Full Time Night (Relo - TX - Sign On Bonus)
Description: Why STC-3 Renal/Transplant Patients accepted on STC-3 arecomplex with multiple cognitive, emotional and physical needs as they attemptto live with new and acute conditions such as surgery or pneumonia, (more...)
Company: Baylor Scott
Location: Mount Vernon
Posted on: 02/21/2020

Registered Nurse - OR - 13 Week Contract
Description: Jackson is in need of highly-skilled Registered Nurses with experience caring for patients requiring surgical procedures for a 13 week contract assignment at a state-of-the-art area hospital. br br (more...)
Company: Jackson Nurse Professionals
Location: White Plains
Posted on: 02/21/2020

Psychiatric Physician Assistant
Description: Position Description Our Multi-Disciplinary clinic needs a Psychiatric Nurse Practitioner or Physician
Company: ENP Network
Location: Lakewood
Posted on: 02/21/2020

Log In or Create An Account

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

White Plains RSS job feeds