Orthopedic Surgery Physician Spine Surgeon - Physicians Only Apply - Perm
Company: UnitedHealth Group
Location: White Plains
Posted on: February 18, 2021
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Job Description:
Medical Doctors Only Apply. A Orthopedic Surgery Physician Spine
Surgeon practice is seeking a qualified physician for White Plains,
NY. This and other physician jobs brought to you by ExactMD.
OrthoNet - Sr. Medical Director, Spine Surgery - White Plains, NY
(627058)
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:
Utilization (Medical) Management
---Directs the utilization management, quality & improvement
activities and monitors all reports, information summaries,
clinical and financial data relating to these activities
---Designs and implements programs to help ensure that all
participating providers deliver quality, cost effective care across
all settings
---Provides direction for development and implementation of new
utilization management programs
---Oversees the development and implementation of policies and
procedures to ensure effective monitoring and management of
clinical interventions
---Oversees implementation of a risk assessment process for the
member population as appropriate
---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 clinician for the coordination of our spine
surgery clinical team. Leads efforts to ensure consistency of
clinical decision making, assures all MDs are aware of current
developments in client and OrthoNet clinical criteria, assures high
quality peer-to-peer coverage and content of discussions,
coordinates on call schedule and aids in recruitment and
professional development as appropriate to OrthoNet roles
Network Services
---Supports existing network management activities to assure that
the appropriate provider network is maintained
---Supports the credentialing activities required for physician and
physical therapy 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
---Maintains liaison relationships with payors and providers in the
community as needed
---Serves as the lead contact with participating provider regarding
OrthoNet activities in spine surgery area. 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:
---M.D. or D.O. degree
---Current and active Unrestricted, Medical license
---Substantial, significant experience in clinical medical
practice/patient care is essential
---Active Board certification required in relevant ABMS-recognized
relevant 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
---Ability to create relationships with demonstrated interpersonal
skills
---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
---Specific 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 musculoskeletal
clinical practice desired. Broad clinical interests and working
knowledge of current clinical practices and major national trends
in health care services
---Proficiency in operating computers applications
---Excellent verbal and written communications skills
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.
Job Keywords: spine surgery, orthopedic surgery, medical
management, utilization review, utilization management, White
Plains, NY, New York
Keywords: UnitedHealth Group, White Plains , Orthopedic Surgery Physician Spine Surgeon - Physicians Only Apply - Perm, Healthcare , White Plains, New York
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