MEDICAL DIRECTOR
Quality Assurance - West Los Angeles, California
Physicians! Are you tired of working in a clinical position? Would you like to
make a career change? Do you find work in the hospital or clinic tiresome, but
still enjoy chart review and working with details? This may be the right job for
you. Use your clinical skills in a new and stimulating way.
Advanced Medical Reviews is currently in search of a physician to act as a
quality assurance manager in our West LA office. This position is responsible
for advancing the quality of our independent reviews by offering clinical
knowledge and advice to our non medical staff. The physician supervisor will
check the reviews to determine accuracy and completeness from a medical
standpoint. We are offering a full time position with work between 8-5pm, Monday
Friday. Work in a professional business environment with no patient contact. We
will provide training for the right candidate with a minimum of 5 years recent
clinical experience. Must be proficient in Word/Excel; typing 45 wpm. Advanced
Medical Reviews is an equal opportunity employer. To learn more about our
company, visit our website at www.admere.com.
Click on the link below to learn more about this position and apply (no need to
reply to this ad via e-mail, simply fill out the information on the link):
https://home.eease.adp.com/recruit/?id=508311
Job Description:
Advanced Medical Reviews offers independent medical review services that are
professional, prompt, customizable, and affordable. Our experienced medical
network provides comprehensive medical opinions utilizing case-specific patient
information and industry-standard care guidelines including treatment protocols
and current scientific evidence.
We help HMO's, TPA's, hospitals, medical insurance carriers, and state health
agencies resolve coverage disputes and evaluate quality of care. Advanced
Medical Reviews provides national coverage with actively practicing
board-certified physicians and licensed healthcare professionals.
We
are currently seeking a full-time physician to act as a utilization review
quality assurance supervisor. The position will be responsible for:
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Providing Quality Assurance of the independent medical
reviews. This includes written and verbal communication with the reviewers,
clients, and staff members.
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Performing Utilization Management services within established
clinical, productivity, phone and URAC standards.
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Applying clinical skills and expertise in conjunction with
established medical criteria to ensure independent reviews are accurate and
complete.
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Serving as a subject matter expert on complex medical
management issues.
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Performing other related projects and duties as assigned.
Accountabilities:
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Responsible for assessing and monitoring services for
inpatient, outpatient, home health care and skilled nursing facilities
utilizing thorough knowledge of multiple criteria sets and products.
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Responsible for maintaining knowledge of community resources
and health plan programs.
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Responsible for preparing documentation to provide the utmost
quality of reviews.
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Responsible for facilitating consistent, sound and defensible
medical decisions, according to established coverage guidelines/policies,
national industry-standard care guidelines, and current scientific evidence
as it applies to each case.
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Efficiently and accurately communicate necessary changes for
the non-medical staff following established timelines.
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Evaluate and analyze available literature on new and existing
technologies to determine safety and effectiveness as it relates to the
quality of independent reviews.
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Ability to abstract pertinent clinical findings and
appropriately apply to corresponding clinical criteria.
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Maintain confidentiality of case information.
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Other duties as assigned.
Required Qualifications:
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MD or DO with an active state license, board certification,
and no negative action on DEA or state license.
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Five years of experience as a physician.
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Excellent verbal and written communication and interpersonal
skills.
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Excellent problem identification/problem solving and follow
through skills.
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Ability to organize and prioritize multiple assignments
within workload.
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Ability to function independently and take independent
action, within the scope of job responsibilities.
Preferred Qualifications:
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Experience in managed care environment
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Experience in as a medical director, utilization review,
utilization management, or quality review
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Experience in working with established criteria to determine
medical necessity and appropriateness of care.
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Demonstrated knowledge and familiarity in research
methodologies and ability to interpret medical literature.
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Computer experience with word processing.
Start Date: ASAP
Location: West Los Angeles Office
Hours: Full time during business hours
Compensation: Negotiable - includes medical, dental, vision, paid time
off, and 401K
Send resume: Go to:
https://home.eease.adp.com/recruit/?id=508311 to apply
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