Weekend Associate Medical Director – 0.3 FTE

🕒 May 13

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

⏱ Part Time

🔴 Lead

👨‍⚕️ Medical Director

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Network Health WI

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1982

⚕️ Healthcare Insurance

👥 B2C

Healthcare Insurance • Insurance • B2C

Network Health WI is a health insurance provider based in Wisconsin, offering a range of coverage options including Medicare Advantage, individual and family plans, and employer group health plans. With over 41 years of experience, Network Health is dedicated to building strong and healthy communities by providing accessible healthcare solutions tailored to the needs of its members. The company prides itself on its local presence and commitment to serving the people of Wisconsin, ensuring quality and trustworthy health coverage.

📋 Description

• Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and out-of-plan providers • Participate in oversight and clinical decision making of the UM program • Contribute to development of quality care guidelines, internal peer review procedures and evaluation of medical care evaluation studies • Provide medical consultation for medical/legal issues, member grievance procedures, and development of new benefit packages • Promote positive relationship between NHP and medical community • Serve as spokesperson for NHP in the medical community and maintains appropriate contact with professional health care organizations • Participate in ongoing recruitment of plan physicians • Assist in development of appropriate medical guidelines and parameters for claims review

🎯 Requirements

• Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction • Member in good standing of the local medical community • An active practitioner of medicine in the NHP service areas • Thorough knowledge of health professional and facilities and standards of practice of medicine in NHP’s service area • Sufficient medical experience and knowledge of the Medicare program to review organization determinations involving medical necessity • Board certified in an ABMS medical specialty

🏖️ Benefits

• Opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood • Reliable internet is required for home office work • Occasional travel required