Medical Director - Radiology - Part Time
What you will be doing:
The Medical Director is responsible for processing UM requests that do not meet guidelines, processing appeals, and educating the ordering providers in peer-to-peer calls.
Key Responsibilities
- Responsible for processing UM requests, appeals, and reconsiderations. Required to write a denial rationale in compliance with health plan and government agencies.
- Required to be compliant with contractual obligations to the health plans and government agencies, and certifications that are maintained by Care to Care.
- Required to participate in quarterly UM meetings.
- Responsible for identifying educational needs and participating in ongoing education and support for the medical and intake staff.
- Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the Chief Medical Officer.
- Responsible for communicating the need for additional clinical information to referring/prescribing providers related to consideration for authorization or modification of a referring provider's request for radiological or diagnostic imaging services.
- Required to collaborate with management to create and implement new process or quality improvement initiatives.
- Responsible for coordinating with UM Intake Specialists to ensure timely and accurate communication of clinical decisions.
- Required to collaborate with the clinical team to review and update clinical criteria guidelines at least annually.
Required Certifications/Licensing
- Current, unrestricted medical license in required specialty (NY, NM or CA license required).
- Board certified in Radiology required.
Required Qualifications
Work Experience: Years of Applicable Experience - 7 or more years
Education: MD: Medicine (Required)
Preferred Qualifications
Skills:
- Strong clinical, management and organizational skills.
- Excellent verbal and written communications skills.
- Proficient computer skills.
- High degree of personal integrity and ethical conduct.
- Self-motivated and directed.
- Works well with others.
Experience:
- Current, unrestricted medical license in required specialty (NY, NM or CA license required).
- Board certified in required specialty (Radiology specialty required).
- Knowledge of regulatory requirements.
Additional Job Requirements:
- Remain in a stationary position for prolonged periods of time.
- Be adaptive and change priorities quickly; meet deadlines.
- Attention to detail.
- Operate computer programs and software.
- Ability to communicate effectively with audiences in person and in electronic formats.
- Day-to-day contact with others (co-workers and/or the public).
- Making independent decisions.
- Ability to work in a collaborative business environment in close quarters with peers and varying interruptions.
Working Conditions: Remote
Travel Requirements: No travel required
Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time.
Compensation: Premier's internal salary range for this role is $155,000 - $289,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location.
Benefits:
- Health, dental, vision, life and disability insurance.
- 401k retirement program.
- Paid time off.
- Participation in Premier's employee incentive plans.
- Tuition reimbursement and professional development opportunities.
Premier at a glance:
- Ranked #1 on Charlotte's Healthiest Employers list for 2019, 2020 and 2022.
- Named one of the World's Most Ethical Companies by Ethisphere Institute for the 13th year in a row.
- The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting.
Equal Opportunity Employer: Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination.
#J-18808-Ljbffr
