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Assistant Medical Director- Employee Health Plan

Cleveland Clinic


Location:
Cleveland, Ohio 44195
Date:
09/12/2018
2018-09-122018-10-12
Work Type:
Employee
Job Status:
Full Time, Part Time
Specialties:
  • Family Medicine
  • General Practice
  • Internal Medicine
  • Occupational Medicine
  • Primary Care
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Job Details

Part time- .4 FTE

Hours:  Monday AM, Thursday AM, all day Friday

Clinical opportunities exist in Cleveland Clinic Community Health to make this a full time opportunity.

Job description:

  • Review all nurse identified denial of services for medical and prescription for final determination.
  • Review all physician/provider requests for increased reimbursement.
  • Review all services that do not meet the medical necessity criteria standards.
  • Review all requests for new technology procedures.
  • Provides consultation to Cleveland Clinic Care Management referral authorization staff, case coordinator nurses regarding medical appropriateness and cost-effectiveness of physician care.
  • Provides consultation to Behavioral Health and Pharmacy initiatives for the Cleveland Clinic EHP.

Requirements

Qualifications:

  1. Educational Requirements: Physician meeting credentialing criteria of the Cleveland Clinic Physician Organization.
  2. Experience Requirements: At least five years of clinical experience. Preferred minimum of two years of medical management: utilization review, case management, disease management and/or quality improvement activities in an HMO or integrated delivery system setting. Experience is occupational health, workers’ compensation and employee wellness a plus. Preferred Masters prepared in MBA, MPH or MHA.
  3. Required Licenses and/or Certificates: Board certified in primary specialty.
  4. Skills and Abilities: In addition to the skills required to manage personnel effectively, this position requires the ability to interface successfully with numerous other practicing and physician executives in a variety of settings.
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