Field Medical Director, MSK Surgery - Orthopedic Surgery
Location
United States
Posted
95 days ago
Salary
$120 - $135 / hour
Seniority
Lead
Job Description
Field Medical Director, MSK Surgery - Orthopedic Surgery
Evolent
• Serve as the Physician match reviewer in Hip/Knee/Shoulder Surgery cases • Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process • Aids and acts as a resource to Initial Clinical Reviewers • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner • Participates in on-going training per inter-rater reliability process
Job Requirements
- MD/DO/MBBS
- A clinical license, active and in good standing, in your home state is required
- Minimum of five (5) years’ experience in the practice of Medicine, post residency
- Active Clinical practice within the last 2 years is highly preferred
- Current, unrestricted clinical license in medicine or required specialty
- Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs
- Active Board Certification in Orthopedic Surgery
- Strong clinical, management, communication, and organizational skills
- Energetic and curious with a passion for quality and value in health care
- Computer Proficiency
- Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA)
- No history of a major disciplinary or legal action by a state medical board.
Benefits
- Health insurance benefits
- Flexible work arrangements
Related Guides
Related Categories
Related Job Pages
More Medical Director Jobs
Utilization Management Nurse
HumanaLouisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off
Become a part of our caring community and help us put health first The Utilization Management Nurse 1 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 1 work assignments are often straightforward and of moderate complexity. The Utilization Management Nurse 1 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Use your skills to make an impact Required Qualifications - Licensed Registered Nurse (RN) in the state of Indiana with no disciplinary action - Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting - Ability to work independently under general instructions and with a team - Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications - Bachelor's degree - Health Plan experience - Previous Medicare/Medicaid Experience a plus - Call center or triage experience - Previous experience in utilization management, discharge planning and/or home health or rehab - LTSS knowledge and experience - Bilingual is a plus Additional Information Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested - Satellite, cellular and microwave connection can be used only if approved by leadership - Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Coder Physician
Omega Healthcare SolutionsFounded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. Works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners. Serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com .
JOB DESCRIPTION Job Title Coder Physician FLSA Non-Exempt Reports to Coding Manager Grade F Location Remote Band 1B Summary/Objective Under limited supervision the Coder Physician reviews medical records and performs coding on all diagnoses, procedures, DRG/APC, and charge codes. The Coder Physician uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder Physician will be charged with maintaining the confidentiality of patient records and procedures. Essential Job Functions - Responsible for abstracting, coding, sequencing and interpreting the clinical information from inpatient, outpatient, emergency department, pro fee, and clinical medical records. - Responsible for the assignment of correct principal diagnoses, secondary diagnoses and principal procedure and secondary procedure codes with attention to accurate sequencing. - Utilizes technical coding principals and DRG/APC reimbursement expertise to assign appropriate codes. - Abstracts and codes pertinent medical data into multiple software programs and/or encoders. Follows official coding guidelines to review and analyze health records. - Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations. - Extracts pertinent data from the patient’s health record and determines appropriate coding for reports and billing documents. - Identifies codes for reporting medical services, procedures performed by physicians. Enters codes into various computer systems dependent upon the various clients. - Track and document productivity in specified systems, maintain productivity levels as defined by the client. - Maintain 95% quality rating - Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. Key Success Indicators/Attributes - Ability to prioritize and multi-task in a fast-paced, changing environment. - Demonstrate ability to work in all work types and specialties. - Demonstrate ability to self-motivate, set goals, and meet deadlines. - Demonstrate leadership, mentoring, and interpersonal skills. - Demonstrate excellent presentation, verbal, and written communication skills. - Ability to develop and maintain relationships with key business partners by building personal credibility and trust. - Maintain courteous and professional working relationships with employees at all levels of the organization. - Demonstrate excellent analytical, critical thinking and problem-solving skills. - Skill in operating a personal computer and utilizing a variety of software applications. - Knowledge of coding convention and rules established by the AHIMA, American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes. - Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation. Supervisory Responsibility No Work Environment This job operates in a remote home office environment. This role routinely uses standard office equipment such as computers and phones. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Position Type/Expected Hours of Work This is a full-time position. Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. This position occasionally requires long hours and weekend work. Travel Minimal travel required; up to 5% Required Education and Experience Successful completion of an AAPC or AHIMA-approved Coding Certificate Program and a minimum of two to four years of current production coding experience in both acute care and profee. Preferred Education and Experience N/A Additional Eligibility Qualifications Must have the following certificates and/or licenses: CPC, COC, CIC, RHIA, RHIT, CCS, and/or CCS-P. Security Access Requirements In addition to the specific security access required by the employee’s client engagement, the employee will have access to the Omega systems set forth in the “Standard Field Employee” profile. Microsoft Office ADP Oracle Reviewmate E1- All Field Employees Standard Employee Standard Coder and Client Access based on client needs. Determined by manager and granted by Audit Implementation Manager Equal Employment Opportunity: Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employee may perform other duties as assigned. Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com AAP/EEO Statement Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com.
Psychiatrist
Included HealthAccess. Answers. Advocacy. We're raising the standard of healthcare for everyone.
Included Health is seeking a 100% Remote Psychiatrist to join our team of dedicated mental health clinicians, under the guidance of a Medical Director. This is a 1099 Independent Contractor position. This role offers the opportunity to help redefine healthcare by providing compassionate, high-quality virtual care to patients across their healthcare journey. You will use video-based visits to diagnose and treat a wide variety of mental, emotional and behavioral disorders. You will provide Psychotropic medication management to assist patients with problems ranging from short-term interpersonal issues to severe, chronic conditions. By using medical and psychiatric data, psychiatrists will aid in the development of treatment plans, monitor the effects of medications, and collaborate with primary care physicians, psychologists, therapists and other healthcare professionals to help patients restore their optimal mental health. Responsibilities: - Assess patients through a video-based encounter - Perform virtual comprehensive mental health evaluations, compile patient medical data, including health history and mental status examination findings - Psychotropic medication management including evaluation of patient medical history, and medication response, adherence and tolerability for each individual patient treated - Develop and implement behavioral health treatment plans, evaluate results of mental health assessments, and provide medication management to patients - Collect, record and maintain sensitive patient information such as examination results, medical history and reports - Conduct monthly chart reviews as part of our peer review QA process, as assigned - No on-call responsibilities - Focus on direct patient care and clinical duties without the requirement of Nurse Practitioner supervision Qualifications and Requirements: - Active and unrestricted M.D. or D.O. medical license in the state of residence required - Graduate of ACGME-accredited psychiatry residency program - Keep up-to-date with continuing medical education - Comfortability navigating video-conferencing platforms and willingness to learn new technology, such as Athena - Experience with technology and an understanding of digital tools and platforms The United States compensation for this Independent Contractor position is $205 per visit hour. Your recruiter will share more about the compensation for this role during the hiring process. About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com. ----- Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.
Psychiatrist
Included HealthAccess. Answers. Advocacy. We're raising the standard of healthcare for everyone.
Included Health is seeking a Full Time Remote Psychiatrist to join our team of dedicated mental health clinicians, under the guidance of a Medical Director. Our Psychiatrists are passionate about caring for patients holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. You will use video-based visits to diagnose and treat a wide variety of mental, emotional and behavioral disorders. You will provide Psychotropic medication management to assist patients with problems ranging from short-term interpersonal issues to severe, chronic conditions. By using medical and psychiatric data, psychiatrists will aid in the development of treatment plans, monitor the effects of medications, and collaborate with primary care physicians, psychologists, therapists and other healthcare professionals to help patients restore their optimal mental health. Responsibilities: - Assess patients through a video-based encounter - Perform virtual comprehensive mental health evaluations, compile patient medical data, including health history and mental status examination findings - Psychotropic medication management including evaluation of patient medical history, and medication response, adherence and tolerability for each individual patient treated - Develop and implement behavioral health treatment plans, evaluate results of mental health assessments, and provide medication management to patients - Collect, record and maintain sensitive patient information such as examination results, medical history and reports - Conduct monthly chart reviews as part of our peer review QA process, as assigned - No on-call responsibilities - Focus on direct patient care and clinical duties without the requirement of Nurse Practitioner supervision Qualifications and Requirements: - Active and unrestricted M.D. or D.O. medical license in the state of residence - Current and active ABPN or AOBNP certification - Graduate of ACGME-accredited psychiatry residency program - Keep up-to-date with continuing medical education - Comfortability navigating video-conferencing platforms and willingness to learn new technology, such as Athena - Experience with technology and an understanding of digital tools and platforms What We Offer: Full-Time: 30hrs/wk min - $316,000/yr on average with guaranteed base + equity + benefits. Additionally, Included Health offers productivity incentives for employees who exceed the visit target. Details of the incentive structure will be discussed during the interview process. Starting base salary for the successful candidate will depend on several job-related factors, which may include, but not limited to, education; training; skill set; years and depth of experience; certifications and licensure; business needs; internal peer equity; organizational considerations; and alignment with geographic and market data. Included Health reserves the right to modify these ranges in the future. For further information, please ask your Recruiter. In addition to receiving a competitive pay, the compensation package may include, depending on the role, the following: - Remote-first culture - 401(k) savings plan through Fidelity - Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance) - Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents - Generous Paid Time Off ("PTO") and Discretionary Time Off ("DTO") - 12 weeks of 100% Paid Parental leave - Up to $25,000 Fertility and Family Building Benefit Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment) - 11 Holidays Paid with one Floating Paid Holiday - Work-From-Home reimbursement to support team collaboration and effective home office work - 24 hours of Paid Volunteer Time Off ("VTO") Per Year to Volunteer with Charitable Organizations Your recruiter will share more about the benefits package for your role during the hiring process. About Included Health Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com. ----- Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants with arrest or conviction records in accordance with the San Francisco Fair Chance Ordinance, the Los Angeles County Fair Chance Ordinance, and California law.


