Internal Medicine Physician General Internist - Physicians Only Apply - Perm
Company: Fortus Group
Location: Baton Rouge
Posted on: June 23, 2022
A Internal Medicine Physician General Internist practice is
seeking a qualified physician for Baton Rouge, LA. This and other
physician jobs brought to you by ExactMD. Medical Doctors Only
Position Purpose: Assist the VP of Clinical Programs to direct and
coordinate the physician component of the utilization management
functions for the Medicare Organization Determination team that
supports health plan business units.
Provides medical leadership for Medicare utilization management
activities, Organizational Determinations, and medical review
activities pertaining to utilization review, quality assurance,
medical review of complex, and controversial or experimental
medical services such as transplants utilizing the services of
Performs case reviews and appeals for all health plans
Facilitates Grand Rounds and case reviews with other clinicians and
external treating providers
Participates as an active member of the Integrated Care team
In collaboration with the VP of Clinical Programs, develops
clinical programs and approaches targeted to improve health
outcomes for complex care and high acuity populations
Assists VP of Clinical Programs in planning, establishing goals and
policies to improve quality and cost-effectiveness of care and
service for members.
Provides medical expertise in the operation of approved quality
improvement and utilization management programs in accordance with
regulatory, state, corporate, and accreditation requirements.
Identifies utilization review studies and evaluates adverse trends
in utilization of medical services, unusual provider practice
patterns, and adequacy of benefit/payment components.
Identifies clinical quality improvement studies to assist in
reducing unwarranted variation in clinical practice in order to
improve the quality and cost of care.
Reviews claims involving complex, controversial, or unusual or new
services in order to determine medical necessity and appropriate
Knowledge/Experience: Requires a Medical Doctor or Doctor of
Osteopathy, board certified preferably in a primary care specialty
(Internal Medicine, Med/Peds, Family Practice, Pediatrics or
Emergency Medicine). Previous experience within a managed care
organization, specifically reviewing for Medicare Organizational
Determinations, preferred. Course work in the areas of Health
Administration, Health Financing, Insurance, and/or Personnel
Management is preferred. Experience treating or managing care for a
culturally diverse population preferred. The candidate must be an
actively practicing physician.
License/Certifications: Board Certification through American Board
Medical Specialties. Current state medical license without
Keywords: Fortus Group, Baton Rouge , Internal Medicine Physician General Internist - Physicians Only Apply - Perm, Other , Baton Rouge, Louisiana
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