Medical Director
Location: Louisville Kentucky
Description: Carewise Health is at present recruited Medical Director right now, this job will be placed in Kentucky. More complete informations about this job opportunity please give attention to these descriptions. Email This Job to a Friend
Carewise Health
Medical Director (0000)
Louisville, Kentucky
This job reports to the
Chief Medical Officer .
Relocation is not ! provided.
This is a
Full-Time
position , working 1st Shift .
Number of Openings for this position:
1
Overview
Carewise Health helps organizations improve the personal health of employees and control healthcare costs.
Our industry-leading health and wellness programs help members build the skills they need to achieve and sustain optimum health. Medical Bill Review ensures that health plans and self-insured employers are billed accurately for the care their members receive. Headquartered in Louisville, Ky., Carewise Health employs approximately 600 registered nurses, health coaches, clinicians, medical directors and other committed professionals.
Job Skills/Requirements
- As a Medical Director, you will leverage your clinical practice experience to provide medical guidance and leadership with regards to the delivery of utilization, quality and case management to our client. You will work close! ly with our clinical nurse units to provide medical oversight ! and case review, improving care coordination and cost effective care delivery. In this role, you will manage a team of physicians. You will work closely with the physicians in a team effort to improve medical m -As a Medical Director, you will leverage your clinical practice experience to provide medical guidance and leadership with regards to the delivery of utilization, quality and case management to our client. You will work closely with our clinical nurse units to provide medical oversight and case review, improving care coordination and cost effective care delivery. In this role, you will manage a team of physicians. You will work closely with the physicians in a team effort to improve medical management processes and guidelines and to participate in client interface and management efforts.
- Responsible for managing a team of physicians.
- Responsible for performance reviews, counseling, and mentoring.
- ! Review procedures requiring prior authorization to determine medical necessity and coverage under a members benefit plan.
- Review requests for admissions to determine medical necessity, coverage and appropriateness of the inpatient setting.
- Conducts concurrent review of inpatient hospital stays, making medical necessity decisions.
- Work closely with concurrent review nurses and discharge planners to improve coordination of care and transition of hospitalized members to lower levels of care.
- Provide peer-to-peer communication involving cases under review to promote cost effective provision of medical services.
- Review cases that involve Home Health services; Durable Medical Equipment; Physical Therapy, Occupational Therapy and Speech Therapy; and imaging.
- Actively participate in ongoing committees.
- Support client meetings as assigned, including reviewing and providing input into client presentations.
- Work a! s part of a team to improve medical management processes including revi! ew criteria development.
- Participate in Carewise Health quality improvement process, making recommendations to improve both clinical and service quality.
- Adhere to regulatory requirements (state and federal), including required turn-around time for reviewer decisions.
- Contribute to strategic planning and function as a leader in validation of the credibility of the clinical process of the services delivered.
- Medical representative participating in client facing activities as needed.
- Other duties as assigned.
- Active unrestricted Kentucky Medical License.
- Board certification in an ABMS recognized specialty.
- 3+ years of experience in a managed care environment, with strong background in utilization management. This requirement could be met by serving on a hospital utilization committee or by working in a practice that submits requests for prior authorization.
- 5+ ! years of clinical practice experience.
- Ability to multi-task and balance multiple priorities.
- Good written and oral communication skills.
- Strong familiarity with utilization management criteria (e.g. Milliman). This requirement could be met based on previous/current hospital admission privileges
Carewise Health provides a generous benefits package including:
- Medical Insurance
- Dental Insurance
- Life Insurance
- Vision Insurance
- Paid Vacation
- Paid Holidays
- Paid Sick Days
- Short Term Disability
- Long Term Disability
- 401K Plan With Company Match
- Tuition Reimbursement
- Employee Assistance Program
- Wellness Programs
- Medica! l Insurance
- Dental Insurance
- Life Insurance
- ! Vision Insurance
- Paid Vacation
- Paid Holidays
- Paid Sick Days
- Short Term Disability
- Long Term Disability
- 401K Plan With Company Match
- Tuition Reimbursement
- Employee Assistance Program
- Wellness Programs
Attention Staffing Agencies: This position is not open for agency submittals. Any candidate submitted without HR approval will be considered an applicant of Carewise Health, not the agency. All Agency Candidates must first be submitted to HR.
If you are interested in applying for employment with Carewise Health and need special assistance or an accommodation to apply for a posted position, call 502-420-5520 to leave a message with your requested accommodation.
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This job starts available on: Sat, 20 Jul 2013 07:54:21 GMT
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