Description
C2C INNOVATIVE SOLUTIONS
https://www.c2cinc.com/
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https://jobs.tmf.org/
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
Position Purpose:
Assists Medical Director in providing physician leadership and quality oversight for the task order or project.
Essential Responsibilities:
Assists in providing leadership to Physician Reviewers and oversees their productivity, production, and decision letter quality. Assists the Medical Director in monitoring Physician Reviewer training and activities during the work week.
Assists in overseeing, directing and monitoring quality and continuous improvement of the quality assurance program, serves as a liaison to the Quality Mangers in helping in reviewing problematic issues and assisting in editing and authoring Decision Consistency m\Memeos.
Performs quality audits of physician reviews and reports findings into the Quality Manger for statistical analysis within the contract.
Develops and monitors reports and data analysis to identify root causes of items that should be improved to improve the overall medical program, works with the Medical Director and Quality Manger and Adjudication manager on all problematic areas of review and quality issues.
Renders medical necessity case decisions and decisions based on federal and state legal and regulatory documents as required and teaches Physician Reviewers the processes needed in the medical review area of the contract.
Minimum Qualifications
Education
Graduate of an accredited medical school
License and Certification
Active State license to practice medicine
Board certification
Experience
Seven (7) years clinical
Three (3) years demonstrated and progressively responsible medical managerial or leadership role
No federal or state sanctions as would appear on reporting from the National Practitioner Data Bank (NPDB)
Medicare Managed Care or Medicare Part C, preferred
Benefits
C2C offers an excellent benefits package, including:
Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
Section 125 plan
401K
Competitive salary
License/credentials reimbursement
Tuition Reimbursement
EOE Vet/Disability
Requirements
Minimum Qualifications
Education
Graduate of an accredited medical school
License and Certification
Active State license to practice medicine
Board certification
Experience
Seven (7) years clinical
Three (3) years demonstrated and progressively responsible medical managerial or leadership role
No federal or state sanctions as would appear on reporting from the National Practitioner Data Bank (NPDB)
Medicare Managed Care or Medicare Part C, preferred
