Physician Opportunities

Position Summary:  We are seeking a part-time (approximately 15 – 20 hours per week) Medical Director to provide clinical leadership and strategic guidance to HQSI’s URAC-accredited Medical Review Services division.

 

 

Responsibilities:

 

  • Serves as subject matter expert in utilization management, healthcare policy and regulations for provider networks, commercial health plans and government agencies
  • Plans, directs and acts as a resource for all aspects of organization’s utilization management policies, standards and programs
  • Provides teaching and guidance to the National Physician Reviewer Panel and nurse reviewers to maintain consistency and quality of clinical decision making
  • Develops educational material and maintains ongoing educational program for clinicians for physician and nurse reviewers
  • Collaborates with Compliance and Quality Assurance/Quality Improvement to consistently assess and improve the quality and efficiency of medical review and support services
  • Develops and maintains relationships with National Physician Reviewer Panel members to distinguish and elaborate specific areas of knowledge, interest and strengths
  • Collaborates with Human Resources to expand and develop depth and diversity of National Physician Reviewer Panel
  • Researches and provides trend and industry data to assist in areas of compliance and strategic organizational development
  • Originates position papers on topics of utilization and appeals management for publication and presentation
  • Represents organization and engages in speaking opportunities at educational and networking conferences, seminars and symposiums; participates in key marketing activities and presentations
  • Cultivates alliances within the healthcare community through the development of strategic relationships
  • Represents organization at the local and national level relevant to medical philosophies, policies and related issues
  • Participates with business development and clinical team during discussions, conference calls, on-site meetings with clients and potential clients to identify and pursue strategic opportunities
  • Assists, as appropriate, with the contracting process with new clients and additional support services
  • Supports URAC and other accreditation and qualification requirements
  • Travels throughout the United States

 

 

Knowledge and Skills Required:

 

  • Utilization and appeals management in areas of benefit coverage, medical necessity, quality of care, DRG and clinical validation
  • Healthcare policy, including federal, state and payer regulatory and contract requirements
  • Ability to provide insight for strategic approach for organizational development and expansion
  • Application of MCG and InterQual guidelines

 

 

Qualifications:

 

  • Graduate of an accredited medical school
  • Current license without restriction
  • Active Board Certification
  • Currently in active practice a minimum of 20 hours per week with at least 5 years’ experience
  • Experience as a Medical Director or Physician Advisor beneficial
  • Demonstrated experience in utilization, appeals and or denials management
  • Course work in the areas of Health Administration, Health Financing, Insurance and/or Personnel Management is a plus
  • Proficient computer skills (Microsoft Office, internal data base system)
  • Excellent interpersonal communication skills (verbal, written, presentation, analytical)
  • Ability to travel throughout the United States

 

 

While this position can be performed remotely, and we invite applicants from across the country to apply, the Medical Director must be available to periodically attend on-site meetings at the home office in East Brunswick, NJ, as well as travel throughout the US as required.

 

 

Interested applicants must submit a cover letter and full CV

 

 

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