Job Vacancy Medical Doctor Allmed Staffing


Job title: Medical Doctor

Company: Allmed Staffing

Job description: A large managed care organization has several remote full-time CONTRACT opportunities for experienced Medical Doctors (MD) or D.O. to serve as Medical Directors and review and process Utilization Management by doing LOC/LOS reviews for inpatient admissions. Need Florida License.

Work from home position. Most of the help is needed in Fl, so living in the East and having an Fl licenses needed.

LOCATION: REMOTE but need to live in the East – preferably FLORIDA

CONTRACT: now till the end of 2022

HOURS: M-F Dayshift, Full-time is 40 hours a week

PAY: $110.50 per hour

QUALIFICATIONS :

  • Current and non-restricted MD or DO license; Board Certified in ABMS Specialty.
  • 2 years prior Utilization Management experience required including determining LOC/LOS reviews
  • Able to work remotely
  • Must have internet access
  • Must be able to complete 40 case reviews/day including P2P that may occur because of denial.
  • Must be able to analyze clinical data and apply appropriate guidelines for review.
  • Previous utilization experience determining LOC/LOS review.

RESPONSIBILITIES

  • Doing LOC/LOS review for inpatient admissions.
  • Complete 40 case reviews/day including P2P that may occur because of denial.
  • Analyze clinical data and apply appropriate guidelines for review.
  • Previous utilization experience determining LOC/LOS review.
  • Owns an end-to-end process.
  • Develops functional, market level, and/or site strategy, plans, production, and/or organizational priorities.
  • Identifies and resolves technical, operational, and organizational problems outside own team.
  • Product, service, or process decisions are most likely to impact entire functions and/or customer accounts (internal or external).
  • Make Clinical Decisions Related to the Provision of Care C) Fully Proficient
  • Research/analyze clinical or other data/information (e.g., medical records, claims data, authorization data, appeals data)
  • Read/interpret medical/clinical literature and apply to understand of research study design and quality of clinical evidence
  • Review/interpret policies, accreditation standards, regulations, etc. related to medical/clinical topics
  • Conduct assessments of medical policies/policy implementation and clinical operations within the organization and department
  • Gather/review clinical and other information related to specific cases or decisions (e.g., contact and listen to providers; case managers)
  • Consider/evaluate concerns/perspectives/requirements related to medical/clinical decisions, policies, and processes (e.g., members, network providers, regulators, accreditors, legal/risk management, and employers)
  • Identify and consider delegate performance as well as company actions, inactions, errors, or omissions that may impact clinical decisions
  • Consider internal and external reviews (e.g., regulatory audits, litigation, market conduct exam outcomes, third party reviews) in making and documenting determinations
  • Make decisions regarding the application of medical policies, programs, organizations, and clinical guidelines
  • Make clinical case review decisions/judgments in relevant areas (e.g., quality of care, case management aspects to address, coverage decisions, prior authorization)
  • Develop clinical understanding outside the specialty or sub-specialty of post-graduate training to broaden clinical expertise and make relevant interpretations
  • Read and interpret contracts (e.g., provider, hospital, benefits, managed care plans) and apply contract provisions to the clinical review process
  • Manage/Influence/Deliver Communications of Clinical Decisions/Programs/Cases/Results
  • Present clinical programs/results to others (e.g., client/employer meetings, physicians, healthcare providers)

Expected salary:

Location: Minneapolis, MN

Job date: Wed, 15 Jun 2022 22:12:44 GMT

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