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Regularly meet with naviHealth's leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues. Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care.
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The Medical Director will serve on the Death Review Committee and works under general directions with considerable latitude for the use of initiative and independent judgement. Participate in Management Team Meetings and will serve as the Utilization Management psychiatrist for the Center and will develop, review and implement medical policies and procedures and other policies and procedures relating to Utilization Management.
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Specifically, the Associate Medical Director is responsible for the following supervision: oversee the performance of 70+ Hospitalist physicians, perform ongoing mentoring and case review as needed, and advise the program in recruiting evaluation and retention.
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Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review.
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Serves as a member of specified committees: Safety Committee, Medication Use Committee, Poison Control Committee, Infection Control Committee, Nutritional Support Committee, and Product Evaluation Analysis and Review Committee.
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Assess scientific/medical and educational needs across a variety of external partners and subsequently develop the strategic direction for support of ISTs and CME activities, including chairing relevant review committees.
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Provide medical expertise and review of global HEOR materials. Support Global Medical Education initiatives (concept, review etc) Cross-functional point of escalation for deliverables requiring medical review.
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Annually review and approve clinical protocols, policies and procedures, and medical disaster plan. Notifies Regional Medical Director and Site Health Services Administrator of schedule changes.
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Leverage business insights and expert feedback to provide active input into the development and review of brand strategy, tactical plans, and financial plan. This role works collaboratively with Medical Affairs and Market Access to leverage clinical data and thought leader development to accelerate the changing treatment paradigm of IgG4-RD and ensure appropriate access for patients.
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St. Luke’s Hospital is the only hospital in Cedar Rapids designated as a Top 50 Heart Hospital six times, has been named a top 50 Hospital in the Nation by Healthgrades, named one of the nation’s 100 Top Hospitals by IBM Watson Health eight times and also has been honored six times as Becker’s Hospital Review ‘100 Great Hospitals in America.
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Peer Review, medical policy/procedure development, provider contracting experience. Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial process.
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Position in this function is responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services.
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Ensure the integrity of program data, evaluate program performance relative to national data, and implement adjustments to care plans, processes, and policies as needed to address any deficiencies Participates in national quality improvement efforts such as those organized by the National PACE Association, AMDA, and other professional groups Develops and oversees peer review systems for clinical staff, and coordinates the performance appraisal of the primary care physician.
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Compensation (negotiable) Employment Type - Contracted Limited part time Come and join us in our state-of-the-art facilities in Homestead, PA. This is a stand-alone Plasmapheresis clinic that needs a (MD/DO) Medical Director 4 - 6 hours per week to do chart review, lab analysis, and clinic oversight.
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The focus of the coverage reviews will be various types of musculoskeletal and other medical/surgical services which will include prior authorizations for spine surgery Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements.
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review job Title: medical director
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