SVP, Medical Director

🕒 il y a 3 mois

🇺🇸 États-Unis – Télétravail

💵 $250 000 - $275 000 / an

⏰ Temps Plein

🔴 Expert

👨‍⚕️ Directeur Médical

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

👻 Score fantôme 45%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Sedgwick

Site WebLinkedInTous les Emplois

10 000+ employés

🏗️ Construction

💼 Conseil

🏥 Santé

Construction • Consulting • Healthcare

Sedgwick est un fournisseur mondial de solutions d'affaires intégrées, de gestion des risques et de prestations, reposant sur la technologie. Ils aident les personnes et les organisations à anticiper et à atténuer les risques grâce à des solutions en administration de sinistres, santé, invalidité, indemnisation chômage et responsabilité, entre autres. Sedgwick propose des services tels que la gestion des sinistres, le conseil en bâtiment, la comptabilité judiciaire et l'ingénierie légale. Leurs spécialités incluent la restauration de biens, la protection de la marque et la prévention des pertes dans plusieurs secteurs, dont l'agriculture, la construction et l'environnement. L'entreprise met l'accent sur la diversité, l'équité et l'inclusion (DEI), ainsi que sur les pratiques environnementales, sociales et de gouvernance (ESG).

Description

• Evaluate medical reports escalated due to deficient information using evidence-based criteria • Provide leadership to dedicated teams of clinicians and claim professionals • Participate in client stewardship discussions, claim roundtables, and complex medical escalations • Support workers’ compensation, disability, FMLA, fitness-for-duty, return-to-work, liability, and safety-sensitive workforce issues • Support Utilization Review, Physician Advisor, care management strategy, vendor alignment, and quality improvement • Apply clinical guidelines and medical literature to recommendations, claim discussions, treatment-plan clarification, and return-to-work/disability decisions • Conduct reviews for treatment-plan clarification, claim denial, disability certification, and duration management • Call treating physicians to discuss facts and evidence and support appropriate claim determinations • Document recommendations in Juris and SharePoint using evidence-based criteria within required time frames • Oversee appeal and review processes, including specialty recommendations for Independent Medical Review • Develop and deliver training materials and presentations • Provide guidance and leadership to client-dedicated leadership teams and team leads • Ensure compliance with policies, service standards, state regulations, and client requirements • Coordinate and evaluate service delivery among the company, partners, and vendors • Review identified appeal cases for quality assurance and participate as a voting member of a client Disability Pension Board • Provide MRO and occupational health expertise in special or escalated cases • Collaborate with other parts of the company and perform other assigned duties • Support quality programs and travel as required • Provide supervisory support, administer personnel policies, interview and hire colleagues, establish performance plans, and conduct performance discussions

🎯 Exigences

• Medical Doctor (M.D.) degree required • Ten (10) years of related experience required • One (1) to three (3) years of utilization review experience • Three (3) years of clinical quality control experience • Medical Director licensure in select states as needed • Knowledge of evidence-based guidelines • Knowledge of ADAA and FMLA • Knowledge of utilization review procedures • Knowledge of clinical quality systems and measurements • Knowledge of regulations, third-party reimbursement, benefit determinations, and payments • Knowledge of statutory requirements of state jurisdictions and ERISA regulations • Knowledge of general claim practices • Knowledge of pharmacy processes and pharmacy benefit management is a plus • Understanding of pain management is a plus • Excellent oral and written communication and presentation skills • PC literacy, including Microsoft Office products • Analytical and interpretive skills • Strong organizational and interpersonal skills • Proven management and leadership skills • Ability to create comprehensive, accurate, and constructive written reports • Ability to work in a team environment and meet or exceed performance competencies • Travel expectations of 25%-30%

🏖️ Avantages

• Blended work environment • Ongoing learning and professional growth opportunities • Three medical plans to choose from • Two dental plans to choose from • Vision plans to choose from • Tuition reimbursement • 401K plan matching 50% on every dollar contributed up to the first 6% saved • 4 weeks PTO your first full year • Disability insurance • Life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits • Reasonable accommodations when applicable and appropriate