Administrative Physician - Physicians Only Apply - Perm

Company: UnitedHealth Group
Location: White Plains
Posted on: November 9, 2024

Job Description:

A Administrative Physician practice is seeking a qualified physician for White Plains, NY. This and other physician jobs brought to you by ExactMD. Medical Doctors Only Apply.

OrthoNet - Senior Medical Director, Payment Integrity - White Plains, NY

Position Description
You're looking for something bigger for your career. How about inventing the future of health care? We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take our already-exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work.(sm)

The Medical Director provides leadership, organization, and direction for all medical management programs and services. Responsible for the overall quality, effectiveness and coordination of the medical services provided through OrthoNet. Directs the Utilization Management, and Quality Improvement programs for the company. The Medical Director will participate in the monitoring of care administration and medical decision making and coordinates provider appeals. He/she may assist the Provider Services staff in all matters involving provider credentialing, issues and relationships. The Medical Director also provides direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. They will serve as the primary liaison between OrthoNet, physicians, and other medical service providers.

Primary Responsibilities:

Payment Integrity
---Lead physician for OrthoNet---s growing family of payment integrity (Focused Claims Review) programs including professional and other health care claim reviews. Coordinates activities of the several teams of OrthoNet physicians and consultants that work in this area
---Expertise with professional procedure coding, claim reviews and appeal activity. Skilled at providing explanations of adverse decisions made on claims
---Strong interest in fraud and abuse detection and prevention
Utilization Management
---Assists in required in aspects of the utilization management, quality & improvement activities and monitors all reports, information summaries, clinical and financial data relating to these activities
---Designs and helps to implement programs to help ensure that all participating providers deliver quality, cost effective care across all settings
---Assists in the development and implementation of policies and procedures to ensure effective monitoring and management of clinical interventions
---Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
Committee and Leadership Responsibilities
---As directed by the Chief Medical Officer leads committees and other work groups to accomplish the key quality improvement and utilization management objectives of OrthoNet
---Serves as, directed by the Chief Medical Officer, on various internal and/or external Committees and in other such capacities
---Serves as lead day-to-day clinician for the coordination of physicians working on payment integrity activities. Leads efforts to ensure consistency of clinical decision making, assures all MDs are aware of current development in client and OrthoNet clinical criteria, assures high quality peer-to-peer coverage and content of discussions, coordinates on call schedules and aids in recruitment and professional development as appropriate to OrthoNet roles
Network Services
---Supports the credentialing activities required for physician and other clinical employees and consultants
---Assists with resolving provider and payor issues including, but not limited to clinical inquiries, claims issues, fee schedule concerns, medical policies, procedures and member/provider appeal coordination
Liaison Activities
---Assists with liaison relationships with payors and providers in the community as needed
---Serves as lead contact with participating provider regarding payment integrity services with OrthoNet activities. Supports other OrthoNet medical directors and staff with broader client, professional, regulatory and community liaison
Regulatory Requirements
---Supports compliance with regulatory agency standards and requirements (i.e. HCFA, NCQA, URAC, state/federal and third party payors)
---Perform all other duties as assigned

Requirements
To be considered for this position, applicants need to meet the qualifications listed in this posting.
Required Qualifications:
---Current and active Unrestricted, Medical license
---M.D. or D.O. degree
---Active Board certification required in ABMS-recognized specialty
---Minimum five years previous experience in a progressive, results-oriented managed care environment, quality improvement, and utilization management and case management experiences strongly preferred
---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
---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
---Strong analytical problem solving and decision-making skills
---Familiarity with managed care accreditation activities and NCQA, URAC and state and federal regulations
---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
---Knowledge in the principles and practice of broad cardiovascular clinical practice desired
---Broad clinical interests and working knowledge of current clinical practices and major national trends in health care service
---Broad understanding of fraud and abuse
---Understanding of coding issues as it pertains to fraud and abuse
---Experience in appeals and grievances in a managed care environment
---Proficient computer skills
---Post-graduate experience in medical practice/patient care is essential
---Leadership positions and academic experiences are of value
---Special interest and experience in payment integrity issues are of key interest
UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 14, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Diversity creates a healthier atmosphere: 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.

Keywords: UnitedHealth Group, Edison , Administrative Physician - Physicians Only Apply - Perm, Administration, Clerical , White Plains, New Jersey