Physician Reviewer
2 weeks ago
- The ideal candidate will leverage their extensive clinical experience to enable delivery of CSBs market-leading strategies, improving the lives of the individuals we serve.
- The CSB Medical Director will work closely with CSBs National Medical Director and CSB leadership to identify opportunities to manage and improve clinical reviews and processes, deploy new innovations, and collaboratively engage clinical expertise across the Enterprise.
- Key Job Functions:
- Provides clinical expertise and support for all departments and divisions related to the clients Medicare Supplement (Medigap) and Individual Supplemental Health and Life (SHL) Insurance products, including but not limited to, Underwriting, Legal, Marketing, Operations, Product, and Claims.
- Has clinical responsibility for helping to ensure the strategic and tactical delivery of project work for our clients Supplemental Health products in forty-nine states and the District of Columbia (DC).
- Provides clinical resources and education to a multi-disciplinary team of nonclinical staff for CSB, responsible for supporting Medigap underwriters in all aspects of the underwriting process, assists SHL Claims Representatives with complex claims consults, appeals and reviews, rescissions, as well as fraud and abuse cases.
- Oversees the Supplemental Benefits Clinical Team (SBCT), which is a multifunctional team that includes Medical Directors, pharmacist(s), data analyst(s), and other ad hoc members as needed from across the Enterprise.
- Works closely with the actuarial team for the clinical integrity of various undertakings, involving underwriting, pricing, claims automation, and cost analysis.
- Responsible for clinical input to the development of new innovative tactics and methodologies to improve cost containment for Medigap and SHL products, such as Preventive Care, vendor solutions, and other medical management initiatives.
Minimum Qualifications
Education & Experience:
- The CSB Medical Director will be a Board-certified physician with current unrestricted medical license with a minimum of 10-years of clinical practice experience. Candidates must be able to obtain medical license and other state licenses as needed.
Competencies & Skills
- Experience in Medigap, Supplemental Health Insurance, and Medical Underwriting is preferred.
- MBA or equivalent experience preferred.
- Proven ability to assess complex issues, recommend change and resolve issues.
- Strong skills in the following areas: teamwork, communication, negotiation, conflict management, problem solving, effective decision making, and cooperative relations with diverse internal and external stakeholders.
- Demonstrated ability to effectively educate clinical staff and non-clinical staff.
- Strong computer skills and technical independence. Data science background a plus.
- Strong strategic thinking, analytical, and decision-making capabilities.
- Accomplished at developing and delivering professional presentations to various audiences, including senior management.
- Able to work independently and under pressure.
- Strong interpersonal skills and collaboration mindset, able to develop effective relationships with internal/external stakeholders.
-
Physician Reviewer
12 hours ago
Nashville, TN, United States Mindlance Full timeremote position; we can consider candidates from our other six states pay should align to conversion salary M-F Evaluates clinical service requests made by an organization's members and providers. Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests. May also provide clinical leadership in other areas of the...
-
Nurse Reviewer I
2 days ago
Nashville, TN, United States Elevance Health Full timeNurse Reviewer I Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be...
-
Nurse Reviewer I
5 days ago
Nashville, TN, United States Elevance Health Full timeNurse Reviewer I Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be...
-
Physician - Hospitalist
2 weeks ago
Nashville, TN, United States AMKY Physician Services LLC Full timeAbout the job Physician - Hospitalist Hello Dr, Hope you are doing well! The hospital is looking for Physician - Hospitalist Nashville, TN Please review below details and let me know the best level of interest: JOB DESCRIPTION: SUBMISSION REQUIREMENTS AS A REMINDER: All candidates must have met the minimum shift availability listed on the job. CV must have...
-
Nashville, TN, United States Intermountain Health Full timeJob Description: Provides extraordinary care to our customers through friendly, courteous, and professional service through a broad understanding of account handling processes, extraordinary interpersonal skills, and the ability to resolve complex issues in a timely and accurate manner. " Please note that a video interview through Microsoft Teams will be...
-
Nashville, TN, United States Aspire Healthcare Full timeAspire Health is an innovative healthcare company that has quickly become a national leader in the provision of community-based palliative care. Aspire specializes in providing an extra layer of support to patients facing a serious illness through an ambitious palliative care program focused on caring for patients in their homes. Aspires clinicians (e.g.,...
-
Nashville, TN, United States Aspire Healthcare Full timeAspire Health is an innovative healthcare company that has quickly become a national leader in the provision of community-based palliative care. Aspire specializes in providing an extra layer of support to patients facing a serious illness through an ambitious palliative care program focused on caring for patients in their homes. Aspires clinicians (e.g.,...
-
Nashville, TN, United States Aspire Healthcare Full timeAspire Health is an innovative healthcare company that has quickly become a national leader in the provision of community-based palliative care. Aspire specializes in providing an extra layer of support to patients facing a serious illness through an ambitious palliative care program focused on caring for patients in their homes. Aspires clinicians (e.g.,...
-
Nashville, TN, United States Aspire Healthcare Full timeAspire Health is an innovative healthcare company that has quickly become a national leader in the provision of community-based palliative care. Aspire specializes in providing an extra layer of support to patients facing a serious illness through an ambitious palliative care program focused on caring for patients in their homes. Aspires clinicians (e.g.,...
-
Nashville, TN, United States Aspire Healthcare Full timeAspire Health is an innovative healthcare company that has quickly become a national leader in the provision of community-based palliative care. Aspire specializes in providing an extra layer of support to patients facing a serious illness through an ambitious palliative care program focused on caring for patients in their homes. Aspires clinicians (e.g.,...
