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Associate Medical Director, ENT (100% Remote)

Company: eviCore Healthcare
Location: Melbourne
Posted on: September 20, 2018

Job Description:

Otolaryngology opening in Melbourne, Florida. This and other physician jobs brought to you by DocCafe.com Associate Medical Director Information

Minimum Requirements:

  • The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in a clinical specialty recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).
  • Have at least 5 years of clinical experience (post residency/fellowship.
  • Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is requiredResponsibilities:
    • Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
    • Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.
    • Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.
    • Documents all actions related to clinical review sessions and attests to appeal review qualifications as required.
    • Maintains files of all reviews as required by law and Health Plans to retrieve reportable data.
    • Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.
    • Supports the annual review of utilization review criteria.
    • Supports and communicates eviCore policy and procedures to the provider community.
    • Participates in strategic planning for and evaluation of the Care Management process/unit.
    • Assists with staff educational training and in-service programs and serves as a clinical resource for eviCore staff. Keyphrases: otolaryngology jobs, otolaryngologist jobs, ear nose throat jobs, ent jobs

      Keywords: eviCore Healthcare, Lakeland , Associate Medical Director, ENT (100% Remote), Executive , Melbourne, Florida

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