UNKNOWN

ADAPTED_NOW

In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._. + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards.

Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise. + Participate in protocol and guidelines development to ensure consistency in the review process. + Actively manage projects and/or participate on project teams that require a physician subject matter expert. + Other duties as assigned. EDUCATION Required + Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Substitutions + None Preferred + Master's Degree in Business Administration/Management or Public Health EXPERIENCE Required + 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) Preferred + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry LICENSES AND CERTIFICATION Required + Medical Doctor or Doctor of Osteopathic Medicine (DO) + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. Preferred + None SKILLS + Critical Thinking + Case Management + Customer Service + Oral & Written Communication Skills + Collaboration + Listening + Telephone Skills + General Computer Skills + Clinical Software + Managed Care Language (Other than English) None Travel Required 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely _Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ _Compliance Requirement_ _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ Pay Range Minimum: $170,000.00 Pay Range Maximum: $352,500.00 _Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J267780

Highmark Health

Medical Director, Clinical Services

Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members ESSENTIAL RESPONSIBILITIES + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise. + Participate in protocol and guidelines development to ensure consistency in the review process. + Actively manage projects and/or participate on project teams that require a physician subject matter expert. + Other duties as assigned. EDUCATION Required + Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Substitutions + None Preferred + Master's Degree in Business Administration/Management or Public Health EXPERIENCE Required + 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) Preferred + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry LICENSES AND CERTIFICATION Required + Medical Doctor or Doctor of Osteopathic Medicine (DO) + Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards + Active medical state licensure required. Additional specific state licensure(s) may be required based on business need. Preferred + None SKILLS + Critical Thinking + Case Management + Customer Service + Oral & Written Communication Skills + Collaboration + Listening + Telephone Skills + General Computer Skills + Clinical Software + Managed Care Language (Other than English) None Travel Required 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely _Disclaimer:_ _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._ _Compliance Requirement_ _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._ _As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy._ _Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._ Pay Range Minimum: $170,000.00 Pay Range Maximum: $352,500.00 _Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._ Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Req ID: J266916

Medical Director

OTHER

FEED

As a receptionist, you directly impact the nursing center reputation being the first person that a patient/resident, family member, candidate or client interacts with at the nursing center.*Answer all incoming calls professionally and courteously and redirect them appropriately.*Warmly welcome, greet and direct patients, visitors, and guests. *Coordinate outgoing and incoming mail.*Maintain current lists of patients/residents by name/room number and employees by names/phone extension.*Order supplies and performs other clerical duties as assigned.

HOUR

Overview:
<div style="text-align:center">Rochester Manor is Now Hiring a part-time Weekend Receptionist!</div><div style="text-align:center">Saturday AND Sunday.  8:30 AM - 4:30 PM.</div><div> </div><div> </div><div>At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve.</div>

Responsibilities:
<div><div>Bring your administrative skills and winning personality to our nursing center. As a receptionist, you directly impact the nursing center reputation being the first person that a patient/resident, family member, candidate or client interacts with at the nursing center.</div><div> </div><div>*Answer all incoming calls professionally and courteously and redirect them appropriately.</div><div>*Warmly welcome, greet and direct patients, visitors, and guests. *Coordinate outgoing and incoming mail.</div><div>*Maintain current lists of patients/residents by name/room number and employees by names/phone extension.</div><div>*Order supplies and performs other clerical duties as assigned.</div></div>

Qualifications:
<div>*High school degree or equivalent is required. *Must be able to read, write, speak and understand the English language to ensure the safety and well-being of our patients and visitors and respond to their medical and physical needs. *Excellent communication skills are required. *Must be proficient with Google; Docs, Sheets, Slides.</div>

Benefits:
<div>*Variable compensation plans *Tuition, Travel, and Wireless Service Discounts *Employee Assistance Program to support mental health *Employee Foundation to financially assist through unforeseen hardships *Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off*Free 24/7 virtual health care provided by licensed doctors for all Anthem medically-enrolled employees and their immediate family members*On-Demand Pay Program that allows for instant access to a portion of the money you’ve already earned We also offer several voluntary insurances such as: *Pet Insurance *Term and Whole Life Insurance *Short-term Disability *Hospital Indemnity *Personal Accident *Critical Illness *Cancer Coverage Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service. </div>

Posted Salary Range:
USD $16.00 - USD $19.00 /Hr.

Rochester Manor

Receptionist

Administrative Skills

Communication Skills

Compensation and Benefits

Employee Assistance Plan

English Language

Healthcare

High School Diploma

Insurance

Life Insurance

Long-Term Care

Nursing

Order Supplies

Physician Credential

Psychiatry and Mental Health

Safety/Work Safety

Team Player

Telephone Skills

Tuition Fees

Wireless Communications

[AW]-iCims

Doctor jobs in Hooksett, NH on your radar? Find the best of them right here on Monster.

The Best Doctor Jobs in Hooksett, NH | Monster

Doctor Jobs in Hooksett, NH

Jobs

Resume Resources

Similar Job Searches

Get noticed by top employers!

Doctor Jobs in Hooksett, NH

Jobs

Medical Director, Clinical ServicesHighmark Health

Medical DirectorHighmark Health

ReceptionistRochester Manor

Resume Resources

Similar Job Searches