Job was saved successfully.
Job was removed from Saved Jobs.
(Archived) Utilization Review Medical Director
Job Description & Requirements
Utilization Review Medical Director in Pennsylvania
StartDate: 02/01/2019Available Shifts: Full Time Pay Rate: $275000.00 - 300000.00
|Practice Description |
- Provide daily utilization oversight and external communication with network physicians and hospitals.
- Responsible for daily UM reviews – authorizations and denial reviews
- Conduct peer to peer conversations for the clinical case reviews
- Conducts provider telephonic review and discussion, schedules on-site visits, shares tools, information and guidelines as they relate to cost-effective healthcare delivery and quality of care
- Communicate effectively with network and non-network providers to ensure the successful administering of naviHealth’s services
- Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
- Represent naviHealth on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
- Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
- Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
- Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
- Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
- Regularly meets with naviHealth’s leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
- Provide input on local needs for Analytics Team and Client Services Team in order to better enhance naviHealth’s products and services
- Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
This is a remote position, you can work from your current residence.
For more information please contact us directly.
MD or DOJob BenefitsAbout the Company
Merritt Hawkins, an AMN Healthcare company, is a permanent physician placement service that fills more physician jobs than any other firm. In addition to being the nation’s leader in physician employment search and consulting services, Merritt Hawkins also recruits and places select allied health professionals. AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer. We encourage minority and female applicants to apply.
Physical Medicine And Rehabilitation, Physiatry, Physiatrist, Pm&R, Physician, Healthcare, Health Care, Patient Care, Hospital, Medical, Doctor, Md, Locum Tenens
Industry Leading Physician Recruiters Merritt Hawkins & Associates is the nation's premier permanent physician search and consulting firm. As the industry leader, our mission is to create enduring permanent matches between healthcare organizations and providers seeking to enhance their professional and personal lives. We also place allied health professionals in select disciplines.