Transforming the health of the communities we serve, one person at a time.
Senior Medical Director – Appeals, National Physical Health UM Team
Location
Missouri
Posted
90 days ago
Salary
$231.9K - $440.5K / year
Job Description
Job Requirements
- Medical Doctor or Doctor of Osteopathy
- 7+ years of clinical experience in the practice of medicine
- Advanced degree in health care management, informatics preferred but not required
- Management experience, 5 years or more of leading large physician teams in a matrixed environment, preferred
- Deep knowledge of Medicare policies and procedures (Manuals, NCD’s, LCD’s, final rules, STARS metrics) and previous experience leading Medicare Appeals, IRE and ALJ hearings, STARS metrics
- Previous experience with ensuring high quality medical director training to review Medicare UM and appeals, Clinical review quality oversight and management
- Utilization Management experience and knowledge of quality accreditation standards preferred
- Experience analyzing and working with complex data sets and knowledge of population health preferred
- Experience treating or managing care for a culturally diverse population preferred
- Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services
- Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Related Guides
Related Categories
Related Job Pages
More Medical Director Jobs
Medical Director – IP Claims Management
HumanaHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Medical Director overseeing clinical authorization processes for Humana's healthcare services
Medical Director – Payment Integrity
HumanaHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Medical Director interpreting clinical standards and decisions for Humana
Oncology Navigation Nurse Practitioner
Careerpuck SandboxAt Thyme Care, we share a passion for transforming the cancer care experience – not just for patients but also for their caregivers and loved ones, as well as those delivering and paying for their care. Committed to redefining the status quo in cancer care. Building a diverse team of problem solvers and critical thinkers. Focused on creating a culture of inclusion and celebrating diverse perspectives.
As an Oncology Navigation Nurse Practitioner, you will be a critical clinical team member caring for our members. You will have three primary responsibilities: Using a telemedicine platform, evaluate and manage members identified by our nursing and provider team who have urgent s...
Associate Medical Director – Gastroenterology, Hepatology
Thermo Fisher ScientificThe World Leader In Serving Science
Associate Medical Director providing oversight for clinical trials at Thermo Fisher Scientific
