Internal Medicine Physician General Internist – Physicians Only Apply – Perm Position Available In East Baton Rouge, Louisiana
Tallo's Job Summary: A Baton Rouge, LA-based Internal Medicine Physician General Internist practice is seeking a qualified physician. The position involves directing and coordinating physician components for utilization management functions within a Medicare Organization Determination team. The ideal candidate must be a board-certified Medical Doctor or Doctor of Osteopathy with experience in managed care organizations. Current state medical license is required.
Job Description
Job Description:
A Internal Medicine Physician General Internist practice isseeking a qualified physician for Baton Rouge, LA. This and otherphysician jobs brought to you by ExactMD. Medical Doctors OnlyApply.
Position Purpose:
Assist the VP of Clinical Programs to direct andcoordinate the physician component of the utilization managementfunctions for the Medicare Organization Determination team thatsupports health plan business units. Provides medical leadership for Medicare utilization managementactivities, Organizational Determinations, and medical reviewactivities pertaining to utilization review, quality assurance,medical review of complex, and controversial or experimentalmedical services such as transplants utilizing the services ofconsultants Performs case reviews and appeals for all health plans Facilitates Grand Rounds and case reviews with other clinicians andexternal treating providers Participates as an active member of the Integrated Care team(ICT) In collaboration with the VP of Clinical Programs, developsclinical programs and approaches targeted to improve healthoutcomes for complex care and high acuity populations Assists VP of Clinical Programs in planning, establishing goals andpolicies to improve quality and cost-effectiveness of care andservice for members. Provides medical expertise in the operation of approved qualityimprovement and utilization management programs in accordance withregulatory, state, corporate, and accreditation requirements. Identifies utilization review studies and evaluates adverse trendsin utilization of medical services, unusual provider practicepatterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist inreducing unwarranted variation in clinical practice in order toimprove the quality and cost of care. Reviews claims involving complex, controversial, or unusual or newservices in order to determine medical necessity and appropriatepayment
Qualifications:
Knowledge/Experience:
Requires a Medical Doctor or Doctor ofOsteopathy, board certified preferably in a primary care specialty(Internal Medicine, Med/Peds, Family Practice, Pediatrics orEmergency Medicine). Previous experience within a managed careorganization, specifically reviewing for Medicare OrganizationalDeterminations, preferred. Course work in the areas of HealthAdministration, Health Financing, Insurance, and/or PersonnelManagement is preferred. Experience treating or managing care for aculturally diverse population preferred. The candidate must be anactively practicing physician.
License/Certifications:
Board Certification through American BoardMedical Specialties. Current state medical license withoutrestrictions.
