Qlarant has a home-based contract opportunity for a physician with experience providing hospice services. In this role, you will perform reviews of medical records and related documentation for medical necessity. In addition, this position supports review determinations during the appeals process including depositions and court testimony. It is preferred that the selected physician is located in California, but other states are acceptable if you have a current, active and unrestricted California clinical physician license.
Please note: This is a contractual arrangement with an hourly rate. There are no guaranteed hours as the work is assigned on an as needed basis.
This position supports our Unified Program Integrity Contract (UPIC) team's efforts to identify and investigate the fraud, waste and abuse (FWA) impacting our nation's Medicare and Medicaid programs. Our Cerritos-based UPIC West team is responsible for FWA investigations covering 16 Western states and territories.
While medical review and support of review determinations will be the primary responsibilities of this position, the Medical Director job description includes the following essential duties and responsibilities. Other duties may be assigned.
Provides clinical information to teams
Medical Review Oversight may include:
Physician peer review activities
Criteria development and assessment
Correspondence regarding review determination
Recruitment, credentialing, and training of expert physician reviewers
Managing the expert physician advisory network in specific geographic areas
Serving on external committees
Professional Relations may include:
Interfacing with external organizations including physician specialty groups, hospital associations, medical societies, affiliates contractors, and state and federal agencies
Discussing specific clinical issues with attending physicians
Health Care Quality Improvement/Assurance may include:
Leading and/or participates in quality improvement projects as needed
Providing clinical input to specific projects as required by the organization or contractors
Supporting project managers or teams with specific collaborative projects as needed
Maintaining working knowledge of current quality improvement issues and tools
Education and/or Experience:
Doctoral degree (MD) with at least 5 years Hospice services clinical experience with a focus on quality improvement and/or quality assurance. Hospice services experience must be current or within the past 5 years.
Advanced degree in public health or health care administration preferred. May consider an equivalent combination of education and experience.
Board Certification in Hospice required.
Knowledge of Medicare/Medicaid required.
Previous experience as a medical reviewer strongly preferred.
Must be willing and able to support review determinations during the appeals process including depositions and court testimony.
Microsoft Office proficiency at a level that allows timely completion of deliverables.
Certificates, Licenses, Registrations: Valid, current, active, and unrestricted California clinical physician license and practice as a health professional in a state or territory of the United States.
Travel Requirements: Travel requirements vary based on contract requirements may require periodic overnight and/or local travel. Must be willing to travel in accordance with company and contract needs.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.
Additional Salary Information: This is a contractual arrangement with an hourly rate. There are no guaranteed hours as the work is assigned on an as needed basis.
Internal Number: 1165-852
About Qlarant, Inc.
Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.
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