NewYorkRecruiter Since 2001
the smart solution for New York jobs

Medical Director Dermatology - Telecommute (Physician #)

Company: Optum
Location: White Plains
Posted on: June 14, 2019

Job Description:

The Medical Director provides leadership, organization, and direction for claims review programs. Responsible for the overall quality, effectiveness and coordination of the medical services provided through OrthoNet. Direct aspects of the medical claims reviews and coordinates these with the Quality Improvement programs for the company. The Medical Director will participate in the all aspects of claim review services including provider telephonic discussions and provider appeals.

The Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. S/he will serve as a liaison between OrthoNet, physicians, and other medical service providers in selected situations primarily related to medical claim reviews.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Reviews surgical and other professional claims for correct coding using clinical record
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
  • Discusses cases and clinical coding 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

    Required Qualifications:
    • Current, active and fully unrestricted Medical license
    • Current, active Internal Medicine Board Certification
    • Specialty training in Dermatology
    • Post Graduate Specialty Training. ABMS or other nationally-recognized further specialized certifications are a plus.
    • 5+ years clinical experience in relevant clinical specialty post residency Preferred Qualifications:
      • Experience in managed care preferred.
      • Prior experience with professional claim coding / claim coding reviews is essential
      • Knowledge of all important claim coding resources and techniques.
      • Excellent verbal and written communication skills
      • Diplomacy and tact in dealing with sensitive issues
      • Must possess 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
      • Proficient computer skills and ability to learn to use OrthoNet clinical and claims software
      • Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel.
      • MS Office (MS Word, Excel, and Power Point)
        Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

        *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
        Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

        UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
        Job Keywords: Physician, MD, Medical Director, Clinical, quality management, derm, dermatology Keyphrases: dermatology jobs, dermatologist jobs, skin dermatologist jobs, cosmetic dermatology jobs, dermatology associates jobs, advanced dermatology jobs, dermatology consultants jobs, pediatric dermatology jobs, pediatric dermatologist jobs, dermatopathologists jobs

Keywords: Optum, New York , Medical Director Dermatology - Telecommute (Physician #), Executive , White Plains, New York

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Software Development Manager
Description: Overall purpose of role You will be a senior developer on our innovative Contact Centre applications at the forefront of the bank's contact with its customers, and the extensive features they support. (more...)
Company: Barclays Tech
Location: Elizabeth
Posted on: 06/28/2019

Telemetry Clinical Nursing Manager
Description: An exciting opportunity is now available in the Southern region of New Jersey for an aspiring Nurse Manager Telemetry Unit. This is a chance to be part of a Prestigious Teaching Hospital in a stable and (more...)
Company: Nurse Management
Location: Brick
Posted on: 06/28/2019

Program Manager
Description: Overall purpose of role Responsible for the
Company: Barclays Tech
Location: Elizabeth
Posted on: 06/28/2019


TELEVISION NEWS DIRECTOR
Description: Untitled Television News Director WFMZ-TV, located in Pennsylvania's
Company: WFMZ-TV
Location: Allentown
Posted on: 06/28/2019

Test data Management
Description: Job Title Test Data Management Consultant Job Location Louisville,
Company: Net2Source Inc.
Location: Scranton
Posted on: 06/28/2019

Project Manager (SFDC)
Description: We are looking for Project Manager SFDC for our client in New Brunswick, NJ Job Title Project Manager SFDC Job Location New Brunswick, NJ Job Type Contract Job Description Project Management of SFDC, (more...)
Company: Cynet Systems
Location: New Brunswick
Posted on: 06/28/2019

Associate Portfolio Manager - Emerging Market Debt, Latin America
Description: Lord Abbett is seeking an Associate Portfolio Manager to support the firm's emerging markets bond team, analyzing sovereign credits primarily across Latin America. br ul li Analyzing and managing (more...)
Company: Lord Abbett
Location: Jersey City
Posted on: 06/28/2019

Plant Manager - Municipal Water, Drinking Water (Chief Operator)
Description: Plant Manager - Municipal Water, Drinking Water Chief Operator Webuild www.webuildstaffing.com is seeking a Municipal Plant Manager to oversee all daily activities related to the operations and maintenance (more...)
Company: Webuild Services LLC / Webuild Staffing
Location: Trenton
Posted on: 06/28/2019

TDM (Test Data Management)
Description: Role TDM Test Data Management Location Bethlehem, PA, USA Type of Employment Full Time - Permanent Base Salary Benefits Relocation Assistance
Company: Net2Source Inc.
Location: Bethlehem
Posted on: 06/28/2019

Project Manager
Description: TSR Consulting has been asked by their valued client, a leading Pharmaceutical Company, to assist with their need for the following role Project Manager Location - New Brunswick, NJ 6 month contract We (more...)
Company: TSR Consulting Services, Inc.
Location: New Brunswick
Posted on: 06/28/2019

Log In or Create An Account

Get the latest New York jobs by following @recnetNY on Twitter!

New York RSS job feeds