Physician Reviewer

If you are interested, please forward your current resume to tezava@w3r.com and you can also reach me at 925-326-2471 to discuss your career aspirations.

Job Title: Physician Reviewer

Location: Remote, Nashville

Duration: 3 Months Contract

Pay Rate: $130.00/hour on W2

Note: This position will M-F 40 hours per week

Job Summary:

• The ideal candidate will leverage their extensive clinical experience to enable delivery of CSBs market-leading strategies, improving the lives of the individuals we serve.
• The CSB Medical Director will work closely with CSBs National Medical Director and CSB leadership to identify opportunities to manage and improve clinical reviews and processes, deploy new innovations, and collaboratively engage clinical expertise across the Enterprise.
• Key Job Functions:
• 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.

Minimum Qualifications

Education & Experience:

• The CSB Medical Director will be a Board-certified physician 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.

Competencies & Skills

• Experience in Medigap, Supplemental Health Insurance, and Medical Underwriting is preferred.
• MBA or equivalent experience preferred.
• 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.