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Physical Medicine and Rehabilitation Full-Time position in San Diego, California
3 months ago
Primary Responsibilities:
- Provide daily utilization oversight and external communication with network physicians and hospitals
- Daily UM reviews - authorizations and denial reviews
- Conduct peer to peer conversations for the clinical case reviews, as needed
- Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care
- Communicate effectively with network and non-network providers to ensure the successful administering of naviHealth's services
- Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
- Represent naviHealth on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders
- Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers
- Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals
- Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees
- Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
- Regularly meet with naviHealth's leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
- Provide input on local needs for Analytics Team and Client Services Team to better enhance naviHealth's products and services
- Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME
- Participate on the Medical Advisory Board
- Providing intermittent, scheduled weekend and evening coverage
- Perform other duties and responsibilities as required, assigned, or requested
Required Qualifications:
- Board certification as an MD, DO, ABPMR with a current unrestricted license to practice and maintain necessary credentials to retain the position
- Current, unrestricted medical license and the ability to obtain licensure in multiple states
- 3+ years of post-residency patient care, preferably in inpatient or post-acute setting
Preferred Qualifications:
- Licensure in multiple states
- Willing to obtain additional state licenses, with naviHealth's support
- Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care
- Demonstrated ability to work within a team environment while completing multiple tasks simultaneously
- Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision
- Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals
- Demonstrated competence in use of electronic health records as well as associated technology and applications
- Proven excellent organizational, analytical, verbal and written communication skills
- Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues
- Proven highest level of ethics and integrity
- Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
