医学主任 医疗运营- Geisinger Health Plan
Medical Director Medical Operations- Geisinger Health Plan
位置：
在家办公（宾夕法尼亚州）班次：
白天（美国）每周计划工作时间：
40工种类型：
正式员工豁免状态：
是职位简介：
医疗总监致力于实现健康计划的主要目标和宗旨。医疗总监将作为持续改进护理和服务质量的积极倡导者。健康计划的医疗总监是该计划在一个运营地理区域内的区域网络中所有健康计划活动的医疗团队负责人。该职位位于每个健康计划/Geisinger运营区域。职位职责：
- 在所有健康计划住院活动中担任医疗管理的领导角色，包括急性住院、LTAC、观察、SNF、康复以及与住院护理相关的各种替代方案，如日间手术。
- 负责持续开发和实施健康计划的住院服务医疗管理计划。
- 与所有健康计划医疗总监密切合作，进一步管理各地区的医疗目标。
- 与医疗之家和信息学的医疗总监密切合作，实施和监控健康计划的医疗管理计划，特别是在住院护理与大型病例管理和疾病管理相关方面。
- 适当支持回顾性理赔审计和理赔检查的医疗部分。
- 支持可保性证明和超龄依赖人流程。
- 为在DME、居家护理和康复问题上工作的Geisinger居家护理护士提供支持。
- 就医疗适当性、福利应用和必要的护理水平等问题提供指导和解释，包括院外护理。
- 确保所有必要文件在规定的时间内得到正确和完整的记录。
- 参与医疗总监值班和值班以及申诉委员会的活动。
- 与医疗管理主任和医疗管理经理一起负责执业者和提供者的申诉流程的行政管理。
- 负责所有与拒绝和申诉相关的医疗总监信函的质量、准确性和及时完成。
- 参与计划药事委员会。工作通常在临床和办公室环境中进行。可能需要出差。需满足所有特定岗位职责并遵守所有组织要求。
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Location:
Work from home (Pennsylvania)Shift:
Days (United States of America)Scheduled Weekly Hours:
40Worker Type:
RegularExemption Status:
YesJob Summary:
The Medical Director is dedicated to the implementation of the Health Plan's primary goals and objectives. The Medical Director will act as a visible champion of continuous improvement in the quality of care and services. The Medical Director for the Health Plan is a medical team leader for all Health Plans' activity within a regional network for one of the Plan's operating geographical areas. The position is based within each the Health Plan/Geisinger operating regions.Job Duties:
- Takes a leadership role in medical management of all Health Plan inpatient activity to include acute inpatient, LTAC, observation, SNF, Rehab and various alternatives related to inpatient care such as ambulatory surgery.
- Responsible for the continued development and implementation of the Health Plan Medical Management Plan for inpatient services.
- Work closely with all Health Plan Medical Directors to further manage medical goals in each region.
- Work closely with the Medical Directors for Medical Home and Informatics in implementing and monitoring the Health Plan Medical Management plan especially as inpatient care relates to large case management and disease management.
- Supports as appropriate the medical component of retrospective claims audit and claims check.
- Supports the Evidence of Insurability and Over Age Dependent process.
- Provides support to the Geisinger Home Health nurses working on DME, Home Health and Rehabilitation issues.
- Provides guidance and interpretation on issues of medical appropriateness, benefit application, and level of care necessary to include out of network care.
- Assure proper and complete documentation of all necessary paperwork within the required timelines.
- Participates in Medical Director On-Call and On-Duty and Appeals Committee activities.
- Responsible administratively for the practitioner and provider appeals process along with the Director of Medical Management and Medical Management managers.
- Responsible for quality, accuracy, and timely completion of all medical directors correspondence related to denials and appeals.
- Participates on the Plan Pharmacy and Therapeutics Committee.
Work is typically performed in a clinical and office environment. Travel may be required. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Position Details:
Education:
Doctor of Medicine or Doctor of Osteopathic Medicine- (Required)Experience:
Certification(s) and License(s):
Licensed Medical Doctor - State of PennsylvaniaSkills:
Office Administration
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.
- KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
- EXCELLENCE: We treasure colleagues who humbly strive for excellence.
- LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
- INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
- SAFETY: We provide a safe environment for our patients and members and the Geisinger family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
Originally posted on Himalayas