Vaughn Job Description Sample
Full Time Occupational Therapist / OT
Client is the leading provider of short- and long-term medical and rehabilitation care is seeking a passionate and driven Occupational Therapist / OT. If you are looking for a challenging and rewarding career assisting our patients in a time of need, then we are looking for YOU!
Caring Philosophy and Commitment:
Our Occupational Therapists / OT are the cornerstone to the client’s commitment to caring. Working in the health care environment can be very demanding, and it is our goal to provide the tools to help our Occupational Therapists / OT understand and commit to the philosophy that defines our culture. Our strength is not just quality of care, but also our quality of caring. We are interested in employing Occupational Therapists / OT who are as passionate as we are about ensuring that our patients and residents receive the care and support services they need and deserve.
- Network of more than 500 in-house long-term care centers, assisted living facilities, outpatient rehabilitation clinics, and home health care & hospice offices
- Outcomes comparable to and often exceeding those of acute care and rehab hospitals in a more cost-effective setting
- State-of-the-art equipment and clean and spacious rehab gyms
- Professional growth and opportunities for advancement
- Flexible scheduling available at select locations
- Mentorship and growth opportunities
- Competitive wages
- Free on-Line CEU Program for full-time/part-time employees (PRN discounted) in addition to in-house CEU's provided
- Comprehensive benefits package
-A Occupational Therapist at our clients plans and administers prescribed Occupational therapy treatment program for patients to restore function, relieve pain, and prevent disability following illness, disease, or injury.
Educational Requirements: Master's degree in Physical Therapy or a foreign degree equivalent as accepted by US Citizenship and Immigration Services or a Bachelor's Degree or foreign degree equivalent plus 5 years of progressive, post-baccalaureate experience.
- Prior experience in Occupational Therapy preferred, but not necessary.
- Currently licensed or registered as an occupational therapist by the state in which practicing, unless that State does not license occupational therapists or otherwise regulate the practice of occupational therapy. Is eligible to take or has successfully completed the NBCOT entry-level certification examination for occupational therapists.
- Credentialed Graduate of an accredited Physical Therapy program, obtained a passing score on the National Physical Therapy Examination and currently licensed in applicable state where working.
- Ideal candidate would have SNF experience and enjoy working with the adult/geriatric populations.
WAH Staff Utilization Management Pharmacist - Variable Staffing Pool
The Staff Utilization Management Pharmacist is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Staff Utilization Management Pharmacist work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Staff Utilization Management Pharmacist completes a review that includes a full analysis of the medication care plan, investigation of overall utilization, and identification of unusual usage patterns. Intervenes and advises patients and providers to promote cost effective utilization and quality patient outcomes, as needed. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
5+ years of technical experience
Must have an active license with the Board of Pharmacy in the appropriate state.
Pharmacy degree from an accredited college of pharmacy.
Licensed as a PHARMACIST in Arizona.
Ability to participate in Federal prescription programs.
Self-directed, but also able to work well in a group.
Ability to solve problems and encourage others in collaborative problem solving.
Work ethic that is focused, accurate, and highly productive.
Excellent communication skills.
Proficient with computers.
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test.
Ability to work either Monday thru Friday (8H shifts); 2:30pm
11:00pm EST or Tuesday thru Friday (10H) shifts; 12:30pm
11:00pm EST with an every 3rd or 4th Saturday rotation.
- 3+ years' experience in a high volume community or mail order pharmacy practice environment.
Scheduled Weekly Hours
Enterprise Data Governance Professional 2
The Enterprise Data Governance Professional 2 implements and operates the company's data governance program, and applies seasoned knowledge to ensure data quality. The Enterprise Data Governance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Humana Military is transforming how health services are defined and delivered. Part of that transformation is how information is managed and used across the organization. Consistent and accurate reference, or master, data allows Humana Military to share accurate, consistent data across the enterprise, improve business process efficiency, and, ultimately, the service and outcomes of our customers.
We are seeking an Enterprise Data Governance Professional 2 to coordinate the collection, maintenance, and administration of provider master data. They will work with analysts and business stakeholders to manage "golden record" provider data elements and manage defined system, process, and data standards.
Ensure quality of master data in key systems, as well as, development and documentation of processes with other functional data owners to support ongoing maintenance and data integrity
Identify areas for data quality improvements and help to resolve data quality problems through the appropriate choice of error detection and correction, process control and improvement, or process design strategies
Assist in resolving data quality problems through the appropriate choice of error detection and correction, process control and improvement, or process design strategies collaborating with subject matter experts (SMEs) and data stewards
Support data governance, data management, and data quality activities and requirements to ensure functional master data integrity across multiple data domains is consistent and meets stated business rules and requirements
Manage, analyze, and resolve data initiative issues and manage revisions needed to best meet internal and customer requirements while adhering to published data standards
Work closely with the internal data management and technology vendor(s) to ensure alignment of master data rules and operation of the application(s) meet all requirements
Our Department of Defense contract requires U.S. Citizenship
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
Bachelor's degree in information science, data management, computer science or related field
Three to five years of experience in data analysis, systems administration, or computer programming
Three to five years' experience as a data analyst in healthcare or a related field including business domain, data/content, and process understanding
Experience working with industry standards, regulations, and guidelines in database warehousing and other relevant systems
Experience working with information security practices and available security software packages
Experience working with domain structures, user authentication, and digital signatures
Experience working with relational databases
Experience in data quality improvement
Strong communication skills with the ability to explain technical concepts and analytics-driven findings to business people and to explain business processes, concepts, challenges, and issues to technical resources.
Experience working with master data technology and model providers
Organizationally savvy, with a good understanding of the enterprise's political climate and how to navigate, influence and persuade political waters
Scheduled Weekly Hours
Manager, Fraud And Waste
The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Bachelor's Degree in health- or business-related field
Prior health insurance claims experience
Excellent PC skills (including MS, Excel and Access) required.
Excellent communication skills, written and verbal
Previous operational leadership and/or progressive business consulting experience
Strong organizational and project management skills
3+ years leading business operations unit
3 or more years of investigative or related experience
Minimum of two years of leadership experience
Experience with Medicare and Medicaid Regulations
Scheduled Weekly Hours
Director, Business Alignment-Cyber Security- Louisville, KY Preferred
The Director, Business Alignment-Cyber Security will be a key member of Humana's information security team, leading the integration of the company's cyber and information protection strategy into the business strategy and execution, and acting as a liaison between Humana's information security organization and all other lines of business. The Director, Business Alignment-Cyber Security builds true strategic partnership with, and manages the relationship between Cyber Security team and the aligned Humana LOB business leadership area, by taking a leadership role in shaping and providing guidance to business partners on cyber security outcomes as a true business enabler, and represents the business and end user interests when developing cyber security solutions. The incumbent will specialize in cyber security and IT risk management, and work directly with the Chief Information Security Officer (CISO) and a team of Regional Information Security Officers (RISO) to assist in the execution and implementation Business Alignment mission.
LOB Regional Information Security Officers (RISO)
Cyber Alignment into Business Strategy and Plans
Relationships with LOB Senior Business Leaders
Security Solutions Management
Key responsibilities include:
LOB Regional Information Security Officers (RISO)
Develop strong relationships and build trust with business leadership.
Leads the communication between cyber security team and all lines of business
Defines the security risk management priorities, aligns the line of business security needs to security tools and capabilities to enforce an agreed security posture
Communicates security requirements and risks to the business
Measures and manages line of business adherence to security goals
Interprets and aligns business priorities and strategies to the cyber security teams
Advocates for user experience for the line of business end users, simplifying the experience and removing the security from the experience while maintaining the highest levels of security/protection for that security, where possible
Aligns the cyber security execution plans with business technology strategy and execution plan.
Collaborates with Humana's subsidiaries and Joint Venture leadership, and with EIP Assurance team to ensure IT security alignment in principle and practice, as needed.
Improves the business awareness of cyber security responsibilities and cyber security outcomes as a true business enabler.
Work closely with Business Technology Leadership (BTL) team as appropriate to align Niteo plans to applicable security strategies.
Security Solution Management
Serve as the single point of contact for business leadership for security solutions and security related support/requests.
Establish and administer the overall strategies and procedures for the information security tools and solutions
Represent EIP to support disaster recovery programs in accordance with organizational information security standards.
Review and update the cybersecurity strategy to leverage new technologies and solutions.
Take a significant role in the development of the information security team and organization to support the engagement, growth, goal achievement, and development of the succession plan for the department.
Provide IT leadership and work collaboratively with Leadership Team members and Department Heads across all divisions, departments and program areas in identifying cross-functional needs and priorities and in developing and implementing appropriate information security solutions.
Manage business solutions ownership in context of security needs, security vendor management where applicable, and security technology lifecycle working with leaders in EIP as well as IT.
Lead/facilitate understanding business needs, gathering security requirements and user experience needs, and developing use cases and stories as applicable for security solutions.
Bachelor's degree in computer science or related field required
15-20+ years of information technology/security management experience.
Fundamental knowledge of cybersecurity administrative principles and practices including planning, risk management, and assessment processes.
Clear ability to communicate persuasively and build business case with senior executives up to the board level.
Work history brings a balance of broad technology skill/knowledge, cyber risk management, as well as business and financial acumen.
Ability to influence others at multiple organizational levels, to lead and work in a team-environment; ability to lead collaborative efforts with users, IT, Cyber Security team, enterprise risk management team, business and support groups.
Ability to assimilate business knowledge and knowledge of internal customer's unique needs/situation and interpret and communicate the appropriate security solution needs to the Cyber Security team.
Previous experience in managing cybersecurity across a diverse set of geographies, lines of business, threat environments, regulatory schemes, and contractual requirements.
A reputation for integrity and willingness to challenge higher levels of management on issues related to information security.
Demonstrated ability to function effectively in a dynamic and challenging environment and to affect change.
Proven ability to analyze problems and issues and to understand the legal and operational impact of decisions from a variety of perspectives.
Demonstrated ability to initiate, plan, execute, and control activities to meet requirements and timelines of system-wide initiatives or projects that are frequently driven by new or changing regulations.
Excellent interpersonal skills with the ability to work with a wide range of staff.
Excellent and dynamic verbal, written, and presentation skills, including the ability to translate complex legal and regulatory requirements and issues into terms readily understood by management.
Demonstrated ability to maintain confidentiality of sensitive material, and exercise good judgment as it relates to handling of sensitive material.
- Master's degree
This position reports to, Chief Information Security Officer, Humana Inc.
Scheduled Weekly Hours
Care Manager, Telephonic Nurse 2 - Humana Government Business
The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
The Case Manager will be a member of the HGB's Integrated Care Team (ICT) encompassing Case Management, Disease Management, and the Personal Nurse program; providing a comprehensive, holistic approach for care management throughout the continuum of care. The case manager will offer guidance and support of the beneficiary's care as directed by the patient's provider(s) and within the scope of the case manager's licensure. The case manager will assess, plan, coordinate, implement, monitor, and evaluate the medical services required to meet the complex health needs of TRICARE beneficiaries, to maximize each beneficiary's capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager will collect and document data to facilitate measurement of case management involvement. As part of the Integrated Care Team, the case manager, will serve as the primary coordinator and point of contact for the beneficiary for all activities within the medical spectrum, including collaboration with Humana Behavioral Health Case Management on cases with dual diagnosis. They will also coordinate with other members of the ICT as needed, in addition to MTF UM / CM staff, physicians and providers as necessary and coordinate and arrange services necessary to address the beneficiary's condition. In their role, the Case Manager will collaborate/coordinate services with other care management programs, to include, but not limited to, Humana at Home, New Beginnings, and End of Life services until the beneficiary's needs are met and case closure or graduation is achieved. Performs all duties within the scope of his/her licensure.
Our Department of Defense Contract requires U.S. citizenship for this position.
Utilize applicable sources of information to identify, assess, and enroll patients requiring case management
Assess, plan, coordinate, implement, monitor, and evaluate the care of each beneficiary under the Case Management / ICT purview across the continuum of care. Develop a cost effective treatment plan that is acceptable to both the beneficiary (patient) and other members of the care team utilizing both evidence based medical information, DoD and community resources. Plan shall include psychosocial issues, home environment and behavioral health needs across the full continuum of care. Maintain beneficiary's privacy, confidentiality and safety, advocacy, adherence to ethical, legal, and accreditation/regulatory standards during this process.
Coordinate and collaborate with other members of the ICT or external programs to ensure a fully integrated care plan addressing all beneficiary needs and conditions; documenting interventions and outcomes for beneficiaries within the case management and ICT team.
Support the Patient Care Coordinators with the coordination of care for beneficiaries not under case management as needed.
Active licensed RN in state of employment
Case Management Certification (CCM) required
Three years clinical or managed care experience
Interqual (or Milliman) knowledge
Good communication skills, verbal and written
Good organizational skills
Our Department of Defense Contract requires U.S. citizenship for this position
Bachelor's degree in nursing or health related field
Two years case management experience
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you
Scheduled Weekly Hours
Senior Risk Management Professional
The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Risk Management Professional estimates the potential financial consequences of an occurring loss. Develops and implements controls and cost-effective approaches to minimize the organization's risks. Assesses and communicates information regarding business risks with functions across the organization. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Additional Job Description:
As a Senior Risk Management Professional, you will work with Medicare and Medicaid compliance performance data, optimizing and analyzing sets of data, to uncovering insights and create powerful visualizations and/or reporting that is easily digestible for broader consumption. You will work collaboratively with other risk and compliance professionals to understand the risks and compliance concerns and then highlight those through powerful visualization tools. Successfully querying data, packaging it in an easy to consume format and effectively communicating outcomes and insights will directly impact our organization's targeting of resources for complex and challenging issues to bring to resolution across the entire organization.
Duties and Responsibilities
Maintain efficiency of data sets through standard practices in data optimization.
Querying data to take complex data sets and break them down to digestible insights.
Develop dashboards and reports using Qlik Sense and/or Tableau to provide on-demand reporting, powerful visualizations and insights.
Collaborate with IT teams to build data tables and establish access.
Work collaboratively with other risk and compliance professionals to reconcile data or uncover patterns that need to be addressed, in easy to understand presentations.
Make recommendations for visualization strategies.
Understanding of database management and data optimization
Adept SQL skills, with detailed experience working on at least one of the following; Oracle, SQL server or Big Data
Experience developing dashboards and reporting which can be used to analyze and identify insights
Experience with common data visualization tools; such as Qlik Sense or Tableau, utilizing it to breakdown complex or large data sets into pointed stories
Skilled at presenting insights and analysis including use of common presentation tools
Demonstrated ability to take initiative, be self-driven, work across functional groups, build collaborative relationships and drive projects to closure
Ability to simplify and translate complex information into easier to understand concepts
Experience with Medicare operations or general understanding of Medicare
Specialization in data science or quantitative field
Experience/training in using data analysis and quantitative modeling techniques (e.g. statistical, optimization, demand forecasting, and simulation) to answer business questions and to assess the added value of recommendations
Experience in working within Humana's Enterprise Data Warehouse
Qlik Sense Certification, Tableau Desktop Associate certification or equivalent, QlikView Business Analyst certification is preferred
Understanding of SharePoint Designer and Workflow creation
Scheduled Weekly Hours
Senior IT Compliance Professional
The Senior IT Compliance Professional works with all parts of IT to ensure that the appropriate controls exist, operate effectively and that information systems procedures are in compliance with industry and corporate standards. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
The Senior IT Compliance Professional works to:
Establish minimum necessary controls within IT processes and frameworks such as the High Performance Systems Development Lifecycle (SDLC).
Participate in the certification process for teams migrating to the High Performance SDLC DevOps toolsets.
Consult with IT and non-IT teams on risk evaluation and control design.
Partner with Internal Audit to understand best practices and requirements in order to meet expectations of external auditors and outside vendor reviews.
Prepare and complete compliance reviews in conjunction with focus areas established by IT Risk Management.
The Senior IT Compliance Professional supports communication and education of new or changed polices involving risk control; Identifies control gaps and supports process to mitigate and close; Facilitates conversations on controls and areas of high risk to determine remediation plans; Identifies changes and trends in IT and the business areas impacting the risks around business led technology solutions.
In addition, the Senior IT Compliance Professional will assist in improving IT Audit and Compliance processes and tools including design and maintenance of the team SharePoint site.
The Senior IT Compliance Professional will:
Identify and monitor areas of risk within Humana's Information Technology.
Operationalize new or changed technology policies involving risk control.
Support communication and education of new or changed polices involving risk control.
Monitor risk controls and collaborates with others on risk mitigation/elimination opportunities.
Facilitate conversations on controls and areas of high risk to determine remediation plans.
Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Source and collect information to identify and monitor areas of risk within Humana's Information Technology.
Compile reporting, preparing it in a business deliverable format, if needed.
Identify changes and trends based on analytical findings.
Collaborate with others on risk mitigation/elimination opportunities.
Drive improvement of internal team processes and tools.
Design and maintain team SharePoint sites.
Bachelor's degree or equivalent work experience
Makes decisions regarding own work methods
Comfortable with ambiguous situations
Requires minimal direction and receives guidance where needed.
Process analyzation and improvement experience
Knowledge of IT Control and Service frameworks such as COBIT 5 or ITIL
Knowledge of different development methodologies (examples: Agile, Waterfall and DevOps)
Demonstrated project management experience, including cross-functional teams
Excellent interpersonal skills including oral and written communications
Comprehensive knowledge of Microsoft Office Tools
Strong research, problem-solving, and analytical skills
Experience in developing and communicating executive level presentations.
Experience with Humana's Systems Development Life Cycle and Project Management frameworks.
Knowledge of Microsoft Azure DevOps and Azure Boards technology
Metrics and report development experience
Work experience in an IT Compliance or IT Audit function
Applicable certifications such as PMP, CISA or CRISC.
SharePoint administration and development experience
Data analytics experience (i.e. Excel – pivot tables, merging of data)
Broad knowledge of Humana's technology framework
Scheduled Weekly Hours
Manager, Network Fabric (Vmware Nsx)
The Manager, Network Administration provides technical expertise in the management of a public and/or private network; tests and analyzes network facilities, including network control software, routers, switches, lines, modems, adapters and servers. The Manager, Network Administration works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
The Manager, Network Administration installs, supports and/or maintains LANs and/or WANs; evaluates and recommends networking product and software upgrades. Performs technical analyses of software, hardware and transmission facilities using various diagnostic tools in support of efficient network operations. Monitors data traffic and controls network resource performance to ensure high-quality transmission. Identifies, diagnoses and resolves technical problems related to network failure/integrity and usage of PC hardware and software. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Humana is seeking a Network Fabric Engineering Manager who will lead an engineering team with the responsibility and accountability to develop, deliver, and ensure supportability for the enterprise network fabric. This is an exciting opportunity for forward-looking technology leaders to make key contributions to the evolution and transformation of the company's networks toward next-generation technologies. This is a critical role within Humana's IT organization responsible for the engineering and design, planning, implementation, and establishment of operational and maintenance programs to deliver best-in-class next generation network infrastructure. This includes optimizing all aspects of network eco-system, including performance, resiliency, availability, resource utilization and innovation. This person will drive implementation of standards and lifecycle processes. This person will be responsible for leveraging state-of-the-art virtualization, automation, and other software-defined networking (SDN) technologies to develop and deliver a robust, scalable, network eco-system. He/she will work with various leaders across the enterprise to coordinate network solutions to meet challenges of technology, regulatory, security, and competitive conditions.The scope includes:
Network fabric for the internal Data Centers / Private Cloud platforms supporting multiple software defined network overlay technologies;
Connectivity solutions for supporting a hybrid cloud environment;
Remote site and campus network technology to support SDWAN implementations;
Internal company wireless connectivity;
WAN circuit topology and telco/carrier technical integration;
Remote user network end point technology.
Engineering responsibilities include:
Design for new solutions;
Standard solution configuration;
Technology roadmap development, management, and maintenance;
Implementation strategies, plans, and execution;
Capacity and performance planning;
Integration with related engineering efforts;
Definition and development of operational KPIs and metrics;
Escalation support for production issues;
Continuous knowledge and skills improvement for the team.
BS/BA, preferably in a technical or scientific field;
5 or more years of network management experience;
Network engineering certification such as CCNA through CCIE or the equivalent;
Experience with implementing and operating a software-defined network environment, especially VMWare NSX;
Experience with implement and operating software defined WAN solutions (SDWAN, NFV, etc.);
Experience managing telco carrier vendors;
Experience interfacing and integrating business and technical requirements;
Project and/or program management experience;
Experience implementing, integrating, and managing public and private cloud platforms.
You will have 8-15 direct reports, and you will report to a Technology Director. This area is under the leadership of the SVP & Chief Information Officer.
Scheduled Weekly Hours
Medical Director - Work At Home Or On-Site Locations Available
The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
5+ years of technical experience
A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
MD or DO degree
Board Certified in an approved ABMS Medical Specialty
Excellent communication skills with 5 years of established clinical experience
Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
Medical management organizations, hospitals and experience, working with health insurance other healthcare providers, patient interaction, etc.
Internal Medicine, Family Practice, Geriatrics, Hospitalist clinical specialists.
Previous Medicare, Medicaid, and/or Commercial experience.
- The Medical Director conducts clinical reviews of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews and/or condition committees. Must hold a MD or DO and be board certified and typically reports to a Lead or Regional or Corporate Medical Director, depending on size of region/line of business. No direct supervisory responsibility is expected though it may occur or the Medical
Scheduled Weekly Hours
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