What are the responsibilities and job description for the Medical Mutual | Assistant Medical Director position at Medical Mutual?
Note, this is a fully remote opportunity; Ohio candidates that reside in the areas of Brooklyn / Cleveland, Toledo, Columbus and Cincinnati.
Provides clinical expertise to promote the delivery of high quality, cost effective, (member centric) medical care. Contributes to the achievement of clinical excellence; quality ratings improvement, appropriate inpatient and outpatient utilization, affordability, compliance, growth and focused improvement and that initiatives are consistently implemented and successfully executed to achieve goals.
Responsibilities
- Provides clinical expertise to the utilization review process and determinations.
- Provides pre-determination reviews and reviews of claims determinations, providing clinical, coding and reimbursement expertise.
- Ensures compliance with clinical goals through monitoring of care management performance.
- Ensures the appropriate and most cost effective medical care is received.
- Recommends changes and enhancements to current managed care, review guidelines, and clinical criteria based on clinical knowledge of health care delivery systems, utilization methods, reimbursement methods and treatment protocols.
- Assists in development and interpretation of medical policy, including medical necessity criteria, clinical practice guidelines, and new technology assessments.
- Provides guidance to case management team in the coordination of quality care.
- Performs other duties as assigned.
Qualifications
Education and Experience
Professional Certifications
Technical Skills and Knowledge
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes :
A Great Place to Work :
Excellent Benefits and Compensation :
An Investment in You :
About Medical Mutual :
We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for over 85 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work / life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in Brooklyn, OH and we have multiple offices throughout the state. Join us at one near you!
At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.
Salary : $5,000
