SVP Medical Director
Location
United States
Posted
4 days ago
Salary
$250K - $275K / year
Seniority
Lead
Job Description
SVP Medical Director
Sedgwick
• To evaluate medical reports escalated due to deficient information utilizing evidence based criteria; • To provide leadership within the dedicated team of clinician and claim professionals. • Participate in client stewardship discussions, claim roundtables, and complex medical escalations. • Stay current on emerging medical trends, treatment standards, clinical literature, and evidence-based guidelines; • Support workers’ compensation, disability, FMLA, fitness-for-duty, return-to-work, liability, and safety-sensitive workforce issues. • Obtain and maintain Medical Director licensure in a few select states, as needed. • Apply applicable clinical guidelines and medical literature to support defensible recommendations, claim discussions, and treatment-plan clarification. • Engage treating providers when needed and support appeals, independent medical review considerations, peer review alignment, and clinical quality review. • Documenting recommendations within templates in Juris and SharePoint using the appropriate format referencing evidence-based criteria within the required time frame. • Developing and delivering training materials and presentations to meet training needs. • Interfacing and providing guidance and leadership to the Client dedicated leadership team as well as team leads.
Job Requirements
- Medical Doctor (M.D.) degree required.
- Ten (10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control.
- Knowledge of evidence-based guidelines
- Knowledge of ADAA and FMLA
- Knowledge of utilization review procedures
- Knowledge of clinical quality systems and measurements
- Knowledge of resources available regarding regulations and parameters of third party reimbursement, benefit determinations and payments
- Knowledge of statutory requirements of state's jurisdiction/ERISA regulations
- Knowledge about general claim practices.
- Knowledge of pharmacy processes and pharmacy benefit management a plus.
- Understanding of pain management a plus.
- Excellent oral and written communication skills, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Proven management/leadership skills
- Ability to create and complete comprehensive, accurate and constructive written reports
- Ability to work in a team environment.
Benefits
- Three medical, and two dental & vision plans to choose from.
- Tuition reimbursement
- 401K plan that matches 50% on every $ you put in up to the first 6% you save.
- 4 weeks PTO your first full year.
- Reasonable accommodations when applicable and appropriate.
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