Qualifications

• Graduate of an accredited medical college in the US and Board certified required.
• 5 years of Clinical practice experience required.
• Experience in musculoskeletal medicine and/or Physical Therapy knowledge required.
• Experience as medical director for a full-service medical health plan / insurance company preferred.
• Experience in Utilization Management (UM) / Medical Necessity Review required.
• Experience in provider discussions related to UM decisions required.
• Experience Clinical Quality Assurance/ Quality Management required.
• General understanding of aspects of Complementary Health Care preferred.
• Ability to provide clinical decision-making and support to staff in support of credentialing, medical necessity review (Utilization Review/Utilization Management) quality assurance, quality improvement, and medical necessity verification activities.
• Ability to find clinical information, validate the information, and apply clinical information to clinical decisions in the context of ASH mission and vision and corporate goal to improve quality and efficiency of health care delivery.
• Ability to deliver Telehealth Medical Consultation in support of ASH Virtual programs as requested.
• Ability to apply for and maintain clinical licenses in states as requested.
• Ability to foster an environment of teamwork and organizational efficiency.
• Ability to understand and develop clinical policy and guidelines in support of clinical staff.
• Excellent computer skills.
• Must have a current, unrestricted medical or osteopathic license in the United States and be able to obtain, and willing and able to maintain, state medical licenses in other states as requested by company required.
• All clinical credentials are active and in good standing with State Board are required.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law.

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

Originally posted on Himalayas