Associate Medical Director, Utilization Management Reviewer
Found in: beBee jobs US - 1 week ago
Company Overview:
Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient's healthcare experience, both in and out of the doctor's office. Founded in August 2019, we are obsessed with eliminating wasteful friction that patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.
Opportunity Overview:
We are looking for physicians who have expertise in general medical topics including medical and surgical clinical areas to deliver on Cohere's program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.
Reporting to the Senior Medical Director for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.
What You Will Do:
- Support the clinical content team in reviewing the company's clinical decision guidelines and evidence based literature
- Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes
- Provide timely medical reviews that meet Cohere's stringent quality and timeliness parameters
- Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines
- Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
- Use correct templates for documenting medical necessity decisions during case review
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
- Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
- Support projects specific to building the team's clinical expertise and efficiency, as delegated
- Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated
Your Background and Requirements:
Required:
- Completed US-based residency program in Internal Medicine or General Surgery
- Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
- 5+ years of clinical practice beyond residency/fellowship in Internal Medicine or General Surgery
Preferred:
- 1+ years of managed care utilization review experience desirable
- Membership in national and/or regional specialty societies
- Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
Competencies/Success Factors:
- Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
- Excels in a matrix organization
- Excellent communication - written and spoken
- Comfortable with technology - willing and able to learn new software tools
- Understanding of managed care regulatory structure and processes
- Detail-oriented, flexible, and able to work autonomously with little supervision
We can't wait to learn more about you and meet you at Cohere Health
Equal Opportunity Statement:
Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it's personal.
#LI-Remote
#BI-Remote
-
Associate Director/Director, Quality Systems and Documentation
Found in: beBee jobs US - 2 weeks ago
Greater Boston Area, United States Scorpion Therapeutics Full timeScorpion is a pioneering clinical-stage oncology company redefining the frontier of precision medicine to deliver optimized and transformational therapies for larger populations of patients with cancer. Scorpion has built a proprietary and fully integrated platform of the most advanced technologies across cancer biology, medicinal chemistry, and data...
-
Utilization Review RN
Found in: Talent US A C2 - 2 weeks ago
Boston, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the...
-
Utilization Review RN
2 days ago
Boston, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Type:Regular Scheduled Hours:40 Work Shift:Day (United States of America) Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on...
-
Utilization Review RN
Found in: Careerbuilder One Red US C2 - 2 weeks ago
Boston, MA, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the...
-
Utilization Review RN
Found in: Adzuna US C2 - 2 weeks ago
Boston, Massachusetts, Massachusetts, 02112, Suffolk County, MA, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:40Work Shift:Day (United States of America)Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on...
-
Utilization Review RN
Found in: Careerbuilder One Red US C2 - 2 weeks ago
Boston, MA, United States Beth Israel Deaconess Medical Center Full timeWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Job Type:Regular Scheduled Hours:40 Work Shift:Day (United States of America) Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on...
-
Associate Medical Director, OLTSS
Found in: Resume Library US A2 - 4 days ago
Boston, Massachusetts, United States University of Massachusetts Medical School Full timeOverview: The Associate Medical Director (AMD) for MassHealth’s Office of Long Term Services & Supports (OLTSS), under the direction of the Director of the Office of Clinical Affairs (OCA) or designee, is responsible for providing clinical expertise to OCA and to the MassHealth program staff in the areas of LTSS. MassHealth, the Commonwealth of...
-
REMOTE: Medical Director, Utilization Management and Medical Policy
Found in: Jooble US O C2 - 2 days ago
Boston, MA, United States Evry Health Full timeAbout the Role Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As a physician, you will work with the actuarial, technology, medical care coordination, and medical quality management teams. You will report directly to the Chief Medical Officer. About Evry Health and Globe Life We are on a mission to...
-
Associate Product Manager
Found in: beBee jobs US - 1 week ago
Greater NYC Area, United States Conair LLC Full timeDescriptionPosition at Conair LLCPosition Summary:Conair, the esteemed market leader in the Garment Care category, is seeking a dynamic Associate Product Manager to join our innovative team. As the Associate Product Manager, you will play a pivotal role in driving the development and execution of strategic initiatives to enhance our product portfolio and...
-
Client Success Associate
Found in: beBee jobs US - 2 weeks ago
Greater Boston Area, United States Maestro Full timeAbout MaestroMaestro is the value creation platform designed exclusively for the Private Equity industry. Backed by S&P Global, Accordion Partners and several General Partners from the PE industry, Maestro helps PE sponsors modernize their operations and maximize value creation within their portfolio through active portfolio management and collaboration with...
-
Director of Psychiatry- Medical Director
Found in: Jooble US O C2 - 2 weeks ago
Boston, MA, United States Boston Medical Center Full timeMedical Director of Addiction Psychiatry Treatment Program (APTP) Boston University School of Medicine, Department of Psychiatry As an academic institution at Boston Medical Center, active engagement in research and education is encouraged with new resources available for program development and scholarly pursuits. Education/supervision opportunities are...
-
Boston, United States Boston Medical Center Full timePOSITION SUMMARY:The Administrative Director for Accreditation and Strategy provides administrative and strategic oversight and direction for all accreditation activities and efforts that fall under the Office of Graduate Medical Education (GME). These activities include the supervision of operations, development and execution of strategic initiatives...
-
Regional Portfolio Director
6 days ago
Boston, United States Trinity Management LLC Full timeTrinity Management, LLC seeks an experienced Portfolio Director. At Trinity Management, LLC, we pride ourselves in providing exceptional, customer-focused property-management services. Our goal is to aid in the revitalization of communities, enhancing the lives of our residents and neighbors, strengthening local commerce, and fostering opportunities for...
-
Associate Medical Director, North America
1 week ago
Boston, United States Rhythm Pharmaceuticals Full timeCompany OverviewRhythm is a global, commercial-stage biopharmaceutical company committed to transforming the care of people living with rare melanocortin-4 receptor (MC4R) pathway diseases. Working at Rhythm means that you are part of a team that's passionate about transforming the lives of people living with hyperphagia (pathological, insatiable hunger) and...
-
Manager of Intake
Found in: beBee jobs US - 2 weeks ago
Greater Boston Area, United States Cohere Health Full timeCompany OverviewCohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient's healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and...
-
Boston, United States Boston Medical Center Full timeMedical Director of Addiction Psychiatry Treatment Program (APTP) Boston University School of Medicine, Department of Psychiatry SUMMARY: The position involves outpatient care of individuals with substance use disorders, including working to support patient engagement with medication for substance use disorders within a nurse care manager model. As an...
-
Associate Medical Director, North America
2 days ago
Boston, United States Rhythm Pharmaceuticals Full timeCompany Overview Rhythm is a global, commercial-stage biopharmaceutical company committed to transforming the care of people living with rare melanocortin-4 receptor (MC4R) pathway diseases. Working at Rhythm means that you are part of a team that's passionate about transforming the lives of people living with hyperphagia (pathological, insatiable hunger)...
-
Implementation Manager
Found in: beBee jobs US - 1 week ago
Greater Boston Area, United States Cohere Health Full timeCompany Overview:Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient's healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and...
-
Associate Medical Director, North America
2 weeks ago
Boston, United States Rhythm Pharmaceuticals Full timeJob DescriptionJob DescriptionCompany OverviewRhythm is a global, commercial-stage biopharmaceutical company committed to transforming the care of people living with rare melanocortin-4 receptor (MC4R) pathway diseases. Working at Rhythm means that you are part of a team that’s passionate about transforming the lives of people living with hyperphagia...
-
Associate Medical Director, North America
Found in: Jooble US O C2 - 2 weeks ago
Boston, MA, United States Rhythm Pharmaceuticals, Inc Full timeRhythm is a global, commercial-stage biopharmaceutical company committed to transforming the care of people living with rare melanocortin-4 receptor (MC4R) pathway diseases. We recognize the courage it takes for patients and their caregivers to begin their journey of advocacy to find the answers they need. As Associate Medical Director in North America...