Full Time Spine Surgery Job in New York

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Full Time Spine Surgery Job in New York

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Full Time Spine Surgery Jobs > New York > White Plains

Spine Surgery

OrthoNet

White Plains, New York

Full Time

You're looking for something bigger for your career. How about inventing the future of health care?  We're pushing ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. As a Medical Director you will use your talents to take our already-exceptional service and innovation to the next level. You will lead a team of world-class professionals who are removing barriers to better health with every new idea. Ready for a new path? Join us and start doing your life's best work.(sm)

The Medical Director provides leadership, organization, and direction for all medical management programs and services.  Responsible for the overall quality, effectiveness and coordination of the medical services provided through OrthoNet.  Directs the Utilization Management, and Quality Improvement programs for the company.  The Medical Director will participate in the monitoring of care administration and medical decision making and coordinates provider appeals.  He/she may assist the Provider Services staff in all matters involving provider credentialing, issues and relationships. The Medical Director also provides direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services.  They will serve as the primary liaison between OrthoNet, physicians, and other medical service providers. 

 
Primary Responsibilities:
 
Utilization (Medical) Management
  • Directs the utilization management, quality & improvement activities and monitors all reports, information summaries, clinical and financial data relating to these activities
  • Designs and implements programs to help ensure that all participating providers deliver quality, cost effective care across all settings
  • Provides direction for development and implementation of new utilization management programs
  • Oversees the development and implementation of policies and procedures to ensure effective monitoring and management of clinical interventions
  • Oversees implementation of a risk assessment process for the member population as appropriate
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
Committee and Leadership Responsibilities
  • As directed by the Chief Medical Officer leads committees and other work groups to  accomplish the key quality improvement and utilization management objectives of OrthoNet
  • Serves as, directed by the Chief Medical Officer, on various internal and/or external Committees and in other such capacities
  • Serves as lead clinician for the coordination of our spine surgery clinical team.  Leads efforts to ensure consistency of clinical decision making, assures all MDs are aware of current developments in client and OrthoNet clinical criteria, assures high quality peer-to-peer coverage and content of discussions, coordinates on call schedule and aids in recruitment and professional development as appropriate to OrthoNet roles
Network Services
  • Supports existing network management activities to assure that the appropriate provider network is maintained
  • Supports the credentialing activities required for physician and physical therapy employees and consultants
  • Assists with resolving provider and payor issues including, but not limited to clinical inquiries, claims issues, fee schedule concerns, medical policies, procedures and member/provider appeal coordination
Liaison Activities
  • Maintains liaison relationships with payors and providers in the community as needed
  • Serves as the lead contact with participating provider regarding OrthoNet activities in spine surgery area.  Supports other OrthoNet medical directors and staff with broader client, professional, regulatory and community liaison
Regulatory Requirements
  • Supports compliance with regulatory agency standards and requirements (i.e. HCFA, NCQA, URAC, state/federal and third party payors)
  • Perform all other duties as assigned

Requirements

To be considered for this position, applicants need to meet the qualifications listed in this posting.
Required Qualifications:
  • M.D. or D.O. degree
  • Current and active Unrestricted, Medical license
  • Substantial, significant experience in clinical medical practice/patient care is essential
  • Active Board certification required in relevant ABMS-recognized relevant specialty
  • Minimum five years previous experience in a progressive, results-oriented managed care environment, quality improvement, and utilization management and case management experiences strongly preferred
  • Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers
  • Excellent verbal and written communication skills
  • Diplomacy and tact in dealing with sensitive issues
  • Ability to create relationships with demonstrated interpersonal skills
  • Must possess leadership skills in working with other physicians, knowledge of the overall medical community and the local/regional managed care environments
  • Strong analytical problem solving and decision-making skills
  • Specific familiarity with managed care accreditation activities and NCQA, URAC and state and federal regulations
  • Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers
  • Knowledge in the principles and practice of musculoskeletal clinical practice desired.  Broad clinical interests and working knowledge of current clinical practices and major national trends in health care services
  • Proficiency in operating computers applications
  • Excellent verbal and written communications skills

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 

Sorry,this is NOT an opportunity for Search Firm recruiters.

Thank you.

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