JOB SUMMARY
A duly licensed doctor of medicine or doctor of osteopathic medicine responsible for clinical oversight of the utilization management program. Functions include training of new clinical staff, professional staff, physician advisors, quality management and improvement, and training and development, as well as participating in customer meetings and quality committee meetings. This is a leadership opportunity to provide governance to physician reviewers, as well as, ongoing training and quality oversight.
**This is a contract position**
MAJOR DUTIES & RESPONSIBILITIES
EDUCATION/CREDENTIALS:
Board Certified M.D. or D.O. with current, unrestricted clinical license in any State in the U.S.
JOB RELEVANT EXPERIENCE:
Minimum five years postgraduate experience. Extensive clinical business background required. Experience working in Utilization Management with criteria review utilizing standard practice guidelines.
JOB RELATED SKILLS/COMPETENCIES:
Working knowledge of URAC and relevant State and Federal compliance guidelines. Excellent communication skills, high level understanding of medical insurance and utilization management, critical thinking, ability to manage time efficiently and to meet specific deadlines. Computer literacy and typing skills required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Any lifting, bending, traveling, etc. that are required to do the job duties listed above. Long periods of sitting and computer work.
WORK FROM HOME TECHNICAL REQUIREMENTS:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement of all work from home position.
This job description is subject to change at any time.
PLEASE BE AWARE: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.
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