REMOTE Physician Reviewer
Location: Nashville, TN, United States
Job Type: Full Time
Job Category: Healthcare
Job Industry: Healthcare Systems and Services
Salary: The pay we're offering is
$105
per hour
Apply now and our proprietary system will quickly have you in front of a live recruiter.
The Opportunity
Description
- Provides clinical expertise and support for all departments and divisions related to the clients Medicare Supplement (Medigap) and Individual Supplemental Health and Life (SHL) Insurance products, including but not limited to, Underwriting, Legal, Marketing, Operations, Product, and Claims.
- Has clinical responsibility for helping to ensure the strategic and tactical delivery of project work for our clients Supplemental Health products in forty-nine states and the District of Columbia (DC).
- Provides clinical resources and education to a multi-disciplinary team of nonclinical staff for CSB, responsible for supporting Medigap underwriters in all aspects of the underwriting process, assists SHL Claims Representatives with complex claims consults, appeals and reviews, rescissions, as well as fraud and abuse cases.
- Oversees the Supplemental Benefits Clinical Team (SBCT), which is a multifunctional team that includes Medical Directors, pharmacist(s), data analyst(s), and other ad hoc members as needed from across the Enterprise.
- Works closely with the actuarial team for the clinical integrity of various undertakings, involving underwriting, pricing, claims automation, and cost analysis.
- Responsible for clinical input to the development of new innovative tactics and methodologies to improve cost containment for Medigap and SHL products, such as Preventive Care, vendor solutions, and other medical management initiatives.
Our Client
Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years’ experience and growth.
Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations.
Big enough to have great opportunities. Small enough to care about finding the right one for you.
It’s about relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success?
Experience Required for Your Success
- Board
Certified (ABMS) M.D. or D.O, with current unrestricted medical license
with a minimum of 10-years of clinical practice experience. Candidates
must be able to obtain medical license and other state licenses as needed.
- Proven
ability to assess complex issues, recommend change and resolve issues.
- Strong
skills in the following areas: teamwork, communication, negotiation,
conflict management, problem solving, effective decision making, and
cooperative relations with diverse internal and external stakeholders.
- Demonstrated
ability to effectively educate clinical staff and non-clinical staff.
- Strong
computer skills and technical independence. Data science background a
plus.
- Strong
strategic thinking, analytical, and decision-making capabilities.
- Accomplished
at developing and delivering professional presentations to various
audiences, including senior management.
- Able
to work independently and under pressure.
- Strong
interpersonal skills and collaboration mindset, able to develop effective
relationships with internal/external stakeholders.
- REMOTE weekend work - at least 2 weekends per month
What Do You Think?
Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?
Apply Now
