Pain Management UM Medical Director Telecommute

Sacramento, CA

full-time
Outpatient

Primary Responsibilities:

  • Performs utilization management reviews for various types of pain management procedures and related services
  • Works with OrthoNet clinical staff to coordinate all the necessary UM processes 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
  • 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


Posted June 4, 2021