Role Description Le médecin évaluateur du pôle adulte est placé sous la responsabilité hiérarchique du chef du pôle adulte. En étroite collaboration avec les autres membres du pôle médical dont il fait partie, il participe, au sein d'une équipe pluridisciplinaire, à l'évaluation globale des besoins et des droits des personnes handicapées ainsi qu’à l'élaboration du Plan Personnalisé de Compensation en s'appuyant sur le projet de vie de la personne. Le caractère technique de l'évaluation médicale comporte : - l'étude des pathologies et des soins mis en place, - l'analyse des déficiences, de leurs conséquences sur le niveau de réalisation des activités, des modalités de compensation mises en place, - l’élaboration du plan de compensation avec les autres professionnels de la MDPH (instructeurs, infirmiers, travailleurs sociaux, psychologues, ergothérapeutes…). Consultez le détail complet de l'offre sur la page ici ou en cliquant sur le bouton "Postuler sur le site employeur". Qualifications - Diplôme d'Etat de Docteur en médecine avec inscription au Conseil de l'ordre des médecins (Médecine générale, médecine hospitalière, médecine physique et de réadaptation, santé au travail...) Requirements - Sens du relationnel, capacité à s’inscrire dans une démarche institutionnelle - Capacité à établir un diagnostic et une évaluation sociale - Aptitude à travailler en équipe - Autonomie et esprit d'initiative - Rigueur, méthode et disponibilité - Connaissance des différents types de handicap, de la politique du handicap, des acteurs et des dispositifs spécifiques (Prestation de Compensation du Handicap, emploi, orientation médicosociale) - Technique de conduite d’entretiens individuels avec les usagers - Capacité à rédiger des écrits professionnels et capacité de synthèse - Maîtrise des outils informatiques et capacité à s’adapter aux outils métiers (logiciels métiers Iodas-Multigest, logiciel de Gestion électronique des documents, Word, Excel) - Maîtrise de l’expression orale (rencontres partenaires)

Conduct thorough reviews of medical records and provide expert opinions on claimants' conditions. Deliver clear written reports within five days and respond to clinical inquiries to support claims management.

• Develops ongoing professional relationships with key decision makers in organized health systems to ensure access to medical and scientific information on the full product portfolio and areas of therapeutic interest • Develops strategic account plans in partnership with the Integrated Account Management (IAM) Account Executive teams and executes medical activities in alignment with agreed plan • Serves as the primary resource for market dynamics within the territory to understand decision makers’ evolving information needs to feed into the ongoing value-proposition development process for product and non-product offerings • Effectively communicates and coordinates with Regional Medical Scientific Director (RMSD) regarding medical and scientific support needs in key health systems accounts • Serves as a resource for the HS MAD Team Lead, HS Executive Director Medical Affairs, and other members of Country Medical Affairs on other relevant strategic planning • Attends and supports scientific and medical meetings and prepares post-meeting deliverables

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit • Provides medical leadership of utilization management, cost containment, and medical quality improvement activities • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making • Supports effective implementation of performance improvement initiatives for capitated providers • Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members • Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership • Conducts regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes • Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals • Participates in provider network development and new market expansion as appropriate • Assists in the development and implementation of physician education with respect to clinical issues and policies • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice to improve the quality and cost of care • Interfaces with physicians and other providers to facilitate implementation of recommendations to improve utilization and health care quality • Reviews claims involving complex, controversial, or unusual or new services to determine medical necessity and appropriate payment • Develops alliances with the provider community through the development and implementation of medical management programs • Represents the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues as needed • Represents the business unit at appropriate state committees and other ad hoc committees • May be required to work weekends and holidays as needed.