Orthopedic/ Neuro Surgery UM Medical Director - Telecommute

Indianapolis, IN

full-time
Outpatient

Primary Responsibilities:

  • Performs utilization management reviews
  • Works with OrthoNet clinical staff to coordinate all the necessary UM processes and provides feedback to OrthoNet staff who do portions of the UM reviews
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
  • Discusses cases and clinical 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

Preferred Qualifications:

  • ABMS or other nationally-recognized further specialized certifications
  • Experience in managed care UM activities
  • 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


Posted June 2, 2021