1,935 Atlantic Health System jobs in the United States

Registered Nurse - Atlantic Health System

07961 Morristown, New Jersey Atlantic Health System

Posted 7 days ago

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Job Description

Responsible for working with other healthcare professionals to help treat patients with various injuries, illnesses or disabilities. Monitors patients, administers medications, keeps records, consults with healthcare providers, educates patients and more.

Principal Accountabilities:

1. Maintains accurate, complete health care records and reports.

2. Administers medications to patients and monitors them for side effects and reactions.

3. Prescribes assistive medical devices and related treatments.

4. Monitors, reports, and records symptoms or changes in patient conditions.

5. Assesses, implements, plans, or evaluates patient nursing care plans by working with healthcare team members.

6. Records patient vital signs and medical information.

7. Performs other related duties as assigned.

ABOUT US

At Atlantic Health System, our promise to our communities is; Anyone who enters one of our facilities, will receive the highest quality care delivered at the right time, at the right place, and at the right cost. This commitment is also echoed in the respect, development and opportunities we give to our more than 20,000 team members. Headquartered in Morristown, New Jersey, we are one of the leading non-profit health care systems in the nation. Our facilities and sites of care include:

* Morristown Medical Center, Morristown, NJ
* Overlook Medical Center, Summit, NJ
* Newton Medical Center, Newton, NJ
* Chilton Medical Center, Pompton Plains, NJ
* Hackettstown Medical Center, Hackettstown, NJ
* Goryeb Children's Hospital, Morristown, NJ
* CentraState Healthcare System, Freehold, NJ
* Atlantic Home Care and Hospice
* Atlantic Mobile Health
* Atlantic Rehabilitation

We also have more than 900 community-based healthcare providers affiliated through Atlantic Medical Group. Atlantic Accountable Care Organization is one of the largest ACOs in the nation, and we are a member of AllSpire Health Partners.

We have received awards and recognition for the services we have provided to our patients, team members and communities. Below are just a few of our accolades:

* 100 Best Companies to Work For and FORTUNE magazine for 15 years
* Best Places to Work in Healthcare - Modern Healthcare
* 150 Top Places to work in Healthcare - Becker's Healthcare
* 100 Accountable Care Organizations to Know - Becker's Hospital Review
* Best Employers for Workers over 50 - AARP
* Gold-Level "Well Workplace": Wellness Council of America (WELCOA)
* One of the 100 Best Workplaces for "Millennials" Great Place to Work and FORTUNE magazine
* One of the 20 Best Workplaces in Health Care: Great Place to Work and FORTUNE magazine
* Official Health Care Partner of the New York Jets
* NJ Sustainable Business

Morristown Medical Center is a nationally-recognized leader in cardiology and heart surgery, orthopedics, gynecology, geriatrics, gastroenterology and GI surgery, pulmonology and lung surgery, and urology.

We are the only hospital in New Jersey named one of America's '50 Best Hospitals' for six consecutive years by Healthgrades and one of the World's Best Hospitals by Newsweek. We were included on Becker's Healthcare 2020 list of "100 Great Hospitals in America". In addition, Leapfrog recognized us with an "A" hospital safety grade - its highest - twelve consecutive times, and the Centers for Medicare and Medicaid Services awarded us again with its highest five-start rating in 2020.

Morristown Medical Center is a Magnet Hospital for Excellence in Nursing Service, the highest level of recognition achievable from the American Nurses Credentialing Center for facilities that provide acute care services. Our nonprofit hospital was also designated a Level I Regional Trauma Center by the American College of Surgeons and a Level II by the State of NJ.

EEO STATEMENT

Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.
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Atlantic Health System is Seeking a Gastroenterologist in New Jersey (Morristown)

07960 Morristown, New Jersey Atlantic Health System

Posted 12 days ago

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Job Description

full time

Atlantic Health System, one of New Jersey's largest non-profit healthcare systems, is seeking additional gastroenterologists to join our growing team with locations in Bayonne, Bridgewater, Morristown, Metuchen, Summit, and Pompton Plains, New Jersey. We are looking for a gastroenterologist to join a well-established group with a large patient panel and robust support staff.

As a member of our team, you will have the opportunity to provide comprehensive care for patients with digestive diseases and work in state-of-the-art medical facilities. We offer the unparalleled opportunity to collaborate with a large GI group and gain the long-term personal and professional satisfaction of serving patients in our diverse community. The ideal candidate is expected to perform the full scope of general gastroenterology as well as assuring the care of patients in both outpatient and inpatient settings are smooth, patient-centric, and safe. This position offers a vast array of clinical care growth and a strong mentorship opportunity!

We have opportunities in the following locations:

  1. Bayonne
  2. Bridgewater
  3. Metuchen
  4. Pompton Plains
  5. Summit (Interventional Only)
  6. Westfield

EARN WHILE YOU LEARN. All residents and fellows can earn a generous monthly stipend paid during their final year of training. We want you to choose our winning team and become part of Atlantic Health System's physician enterprise.

Qualifications

  • BE/BC in Gastroenterology
  • Both new and experienced providers are encouraged to apply
  • Must be licensed or eligible for licensure in New Jersey

Benefits

  • Competitive salary
  • Robust benefits with health, dental, Rx and vision plans
  • 403b retirement plan with company match
  • Comprehensive Malpractice Policy
  • Non-Profit Health System eligible for Federal Student Loan Forgiveness
  • Generous PTO, annual sick days, and paid holidays
  • CME allowance and reimbursement for CDS/DEA, licensing, and boards
  • Tuition reimbursement for advanced degrees
  • Outstanding growth & mentorship opportunities

Please apply to learn more about our opportunities.

Gastroenterologist Positions Atlantic Health System

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Endocrinology Physician Job with Atlantic Health System in NJ (, NJ, United States)

08859 Madison Park, New Jersey PracticeLink

Posted 12 days ago

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Job Description

full time
Endocrinology Physician Job with Atlantic Health System in NJ

Join to apply for the Endocrinology Physician Job with Atlantic Health System in NJ role at PracticeLink .

Atlantic Health System, a leading non-profit healthcare organization in New Jersey, is seeking an experienced Endocrinologist to join our expanding team at a new outpatient practice in Sparta, New Jersey. The Endocrinologist will have inpatient responsibilities at Newton Medical Center. As a key member of our Endocrinology team, youll have access to cutting-edge technology, collaborate with a highly skilled healthcare professional team including RN and RD CDCES, and contribute to an environment committed to exceptional patient care and professional growth.

The ideal candidate will play a pivotal role in growing the practice, working alongside two supportive nurse practitioners, and making a positive impact on the community by providing specialized care to those with endocrine disorders and related conditions. With a Monday-Friday work schedule, this role offers a great work/life balance.

Sussex County, New Jersey, boasts excellent schools, offering a high-quality education, while its advantageous location provides residents with easy access to major cities and the scenic Pocono Mountains.

Please Apply To Learn More About This Opportunity.

Qualifications:
  • BE/BC in Endocrinology
  • 2 or more years of experience is preferred, but new graduates are welcome to apply
  • Must be licensed or eligible for licensure in the State of New Jersey
Benefits:
  • Competitive salary
  • Robust benefits with health, dental, Rx and vision plans
  • 403b retirement plan with company match
  • Reimbursement for Relocation
  • Comprehensive Malpractice Policy
  • Non-Profit Health System eligible for Federal Student Loan Forgiveness
  • $3500 for Annual CME and Time Off, incremental to PTO days
  • Full reimbursement for Boards and Licensing fees
  • Tuition reimbursement for Advanced Degrees
  • Outstanding growth & mentorship opportunities

ID: 34927

Seniority level
  • Entry level
Employment type
  • Full-time
Job function
  • Health Care Provider
Industries
  • Hospitals and Health Care
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Pediatrics - Pulmonology Physician Job with Atlantic Health System in Morristown, NJ (Morristown)

07960 Morristown, New Jersey PracticeLink

Posted 12 days ago

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Job Description

full time
Pediatrics - Pulmonology Physician Job with Atlantic Health System in Morristown, NJ

Join to apply for the Pediatrics - Pulmonology Physician Job with Atlantic Health System in Morristown, NJ role at PracticeLink

Pediatrics - Pulmonology Physician Job with Atlantic Health System in Morristown, NJ

6 days ago Be among the first 25 applicants

Join to apply for the Pediatrics - Pulmonology Physician Job with Atlantic Health System in Morristown, NJ role at PracticeLink

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Atlantic Health, one of New Jersey's largest non-profit healthcare networks, is seeking an additional Pediatric Pulmonologist to join the Pulmonology and Respiratory Center for Children at Morristown Medical Center and Overlook Medical Center. Our highly trained team of pediatric physicians provide a full range of pediatric pulmonary care services, including full pulmonary function testing and bronchoscopy capabilities. We are an approved CFF Care Center and run the pediatric sleep medicine program.

EARN WHILE YOU LEARN. All residents and fellows have the opportunity to earn a generous monthly stipend paid during your final year of training. We want you to choose our winning team and become part of Atlantic Health System s physician enterprise.

Responsibilities

  • This role is ideal for an ambitious and skilled pediatric pulmonologist to join a well-established practice with a robust staff.
  • The ideal candidate should be collaborative and will be responsible for providing direct outpatient care to patients with possible pediatric pulmonary disorders at Atlantic Health System Hospitals, outpatient facilities and associated satellite locations.
  • This position will have both clinical and academic responsibilities including primary and consultative inpatient and outpatient responsibilities.

Qualifications

  • Must be BE/BC in Pediatrics and Pulmonary Medicine
  • Must be licensed or eligible for licensure in the State of New Jersey
  • Open to New Graduates and Experienced Physicians
  • Demonstrated success working individually and as part of a team

Benefits

  • Competitive salary
  • Robust benefits with health, dental, Rx and vision plans
  • 403b retirement plan with company match
  • 457b retirement plan for physicians
  • Comprehensive Malpractice Policy
  • Non-Profit Health System eligible for Federal Student Loan Forgiveness
  • Generous PTO, annual sick days, and paid holidays
  • CME allowance and reimbursement for CDS/DEA, licensing, and boards
  • Tuition reimbursement for advanced degrees
  • Outstanding growth & mentorship opportunities

Seniority level
  • Seniority level Not Applicable
Employment type
  • Employment type Full-time
Job function
  • Job function Health Care Provider
  • Industries Hospitals and Health Care

Referrals increase your chances of interviewing at PracticeLink by 2x

Sign in to set job alerts for Pediatrician roles. Pediatric Urgent Care Physician/PEM - Livingston, NJ - (Full-Time/Part-Time) Cosmetic Surgery Fellowship - Open to Board-Certified Surgeons Pediatric Urgent Care Physician/PEM - Pompton Plains, NJ - (Full-Time/Part-Time) Physician, Department of Pediatrics Rowan Virtua SOM, Open Rank Pediatric Urgent Care Physician/PEM - Pompton Plains, NJ - (Full-Time/Part-Time) OB/GYN Physician (OPEN RANK) Rowan Virtua SOM Physician, Pediatric Hospitalist, Goryeb Children's Hospital, Morristown, NJ OB Hospitalist (Per Diem), Morristown Medical Center Chairperson -Department of OB/GYN Physician (OPEN RANK) Rowan Virtua SOM Dermatology Advanced Practice Provider (NP/PA) Pediatric Urgent Care Physician/PEM - Paramus, NJ - (Full-Time/Part-Time) OBGYN opening with thriving private group- Central NJ - $350K+ New ER Doctor (NERD) Program: Starts October 2025, Practicing Veterinarians - Hoboken, NJ Pediatric Urgent Care Physician/PEM - Paramus, New Jersey - (Full-Time/Part-Time) Pediatric Urgent Care Physician/PEM - Staten Island, NY (Part-time) Hospitalist Leadership Opportunity in New Jersey - 5 miles from NYC

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Hospitalist Physician Job with Atlantic Health System in NJ (, NJ, United States)

08859 Madison Park, New Jersey PracticeLink

Posted 12 days ago

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Job Description

full time
Hospitalist Physician Job with Atlantic Health System in NJ

Join Atlantic Health System, one of New Jersey's largest non-profit healthcare networks, as a Nocturnist . Play a crucial role in providing critical and compassionate care during nighttime hours, ensuring continuous patient well-being and contributing to a seamless healthcare experience.

Position Highlights
  • Supported admissions by advanced practice clinicians and/or residents
  • Use of EPIC EMR system
  • Full subspecialty support
  • Opportunities for moonlighting and teaching
Qualifications
  • Board Eligible or Board-Certified Physicians
  • Active DEA, CDS, and Medical State License required
  • Open to both new graduates and experienced physicians
Benefits
  • Competitive salary
  • Health, dental, Rx, and vision plans
  • 403b retirement plan with company match
  • Comprehensive malpractice insurance
  • Eligible for Federal Student Loan Forgiveness
  • Generous PTO, sick days, and holidays
  • CME allowance and reimbursement for licensing, boards, and CDS/DEA
  • Tuition reimbursement for advanced degrees
  • Growth and mentorship opportunities
Job Details
  • Seniority level: Entry level
  • Employment type: Full-time
  • Job function: Healthcare Provider
  • Industry: Hospitals and Healthcare
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Hematology and Oncology Physician Job with Atlantic Health System in NJ (, NJ, United States)

08859 Madison Park, New Jersey PracticeLink

Posted 12 days ago

Job Viewed

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Job Description

full time
Hematology and Oncology Physician Job with Atlantic Health System in NJ

Join to apply for the Hematology and Oncology Physician role at Atlantic Health System in NJ through PracticeLink .

Atlantic Health System, one of New Jersey's largest non-profit healthcare networks, is seeking a dedicated Hematology/Oncology Physician to join our expanding oncology practice. This role involves providing comprehensive care at Newton Medical Center and our outpatient practice in Sparta. Our team includes board-certified cancer specialists with extensive training in oncology and hematology, offering coordinated care including chemotherapy, radiation therapy, and supportive services.

Our Cancer Care program provides access to leading specialists, cutting-edge technology, and participation in over 75 clinical trials, advancing cancer research and treatment. We serve over 6,000 patients annually.

Qualifications
  • Fellowship trained and board certified in medical oncology and/or hematology
  • Proven success working independently and in team settings
Benefits
  • Competitive salary
  • Extensive benefits including health, dental, Rx, and vision plans
  • 403b retirement plan with company match
  • Comprehensive malpractice coverage
  • Eligible for Federal Student Loan Forgiveness (Non-Profit status)
  • Generous PTO, sick days, and paid holidays
  • CME allowance and reimbursement for licensing, DEA, and boards
  • Tuition reimbursement for advanced degrees
  • Growth and mentorship opportunities
Additional Details
  • Seniority level: Entry level
  • Employment type: Full-time
  • Job function: Healthcare Provider
  • Industries: Hospitals and Healthcare
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Cardiology - Non-Invasive Physician Job with Atlantic Health System in NJ (, NJ, United States)

08859 Madison Park, New Jersey PracticeLink

Posted 12 days ago

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Job Description

full time
Cardiology - Non-Invasive Physician Job with Atlantic Health System in NJ

Join to apply for the Cardiology - Non-Invasive Physician role at Atlantic Health System in NJ through PracticeLink .

Atlantic Medical Group is currently recruiting Non-Invasive Cardiologists to join Atlantic Health System, a recognized leader in cardiovascular medicine with New Jersey's largest cardiac surgery program. The group offers access to a full spectrum of cardiovascular treatments and heart health services.

Atlantic Medical Group, a physician-led multispecialty organization with over 1,200 physicians and advanced practice providers across more than 400 practice locations, all connected via a single electronic medical record, offers a vibrant and growing medical community.

We are seeking Non-Invasive Cardiologists for the following locations:

  • Lakeland Cardiology - Mountain Lakes, Randolph, Rockaway
  • Atlantic Cardiology - Morris/Essex County or Parsippany/Livingston

Earn while you learn: Residents and fellows can earn a generous monthly stipend during their final year of training. Join our team and become part of the Atlantic Health System physician enterprise.

Benefits include:
  • Competitive salary
  • Robust benefits: health, dental, Rx, vision
  • 403b retirement plan with company match
  • Comprehensive malpractice insurance
  • Eligible for Federal Student Loan Forgiveness
  • Generous PTO, sick days, paid holidays
  • CME allowance, licensing, DEA, and board reimbursement
  • Tuition reimbursement for advanced degrees
  • Growth and mentorship opportunities
Qualifications:
  • Board Certified/Eligible in Cardiology
  • NJ licensed or eligible for licensure
Additional Details:
  • Employment type: Full-time
  • Job function: Healthcare Provider
  • Industry: Hospitals and Healthcare
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About the latest Atlantic health system Jobs in United States !

Medical Director, Clinical Services

02298 Boston, Massachusetts Massachusetts Staffing

Posted today

Job Viewed

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Job Description

Job Opportunity At Highmark Inc.

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.

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

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 HR Services Online at

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Medical Director, Clinical Services

70873 Baton Rouge, Louisiana Louisiana Staffing

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

Job Opportunity At Highmark Inc

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.
  • 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.

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

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.

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.

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Medical Director, Clinical Services

65109 Brazito, Missouri Missouri Staffing

Posted 3 days ago

Job Viewed

Tap Again To Close

Job Description

Job Opportunity At Highmark Inc.

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.

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

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 HR Services Online at

View Now
 

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  10. account_balance Banking & Finance
  11. local_florist Beauty & Wellness
  12. restaurant Catering
  13. volunteer_activism Charity & Voluntary
  14. science Chemical Engineering
  15. child_friendly Childcare
  16. foundation Civil Engineering
  17. clean_hands Cleaning & Sanitation
  18. diversity_3 Community & Social Care
  19. construction Construction
  20. brush Creative & Digital
  21. currency_bitcoin Crypto & Blockchain
  22. support_agent Customer Service & Helpdesk
  23. medical_services Dental
  24. medical_services Driving & Transport
  25. medical_services E Commerce & Social Media
  26. school Education & Teaching
  27. electrical_services Electrical Engineering
  28. bolt Energy
  29. local_mall Fmcg
  30. gavel Government & Non Profit
  31. emoji_events Graduate
  32. health_and_safety Healthcare
  33. beach_access Hospitality & Tourism
  34. groups Human Resources
  35. precision_manufacturing Industrial Engineering
  36. security Information Security
  37. handyman Installation & Maintenance
  38. policy Insurance
  39. code IT & Software
  40. gavel Legal
  41. sports_soccer Leisure & Sports
  42. inventory_2 Logistics & Warehousing
  43. supervisor_account Management
  44. supervisor_account Management Consultancy
  45. supervisor_account Manufacturing & Production
  46. campaign Marketing
  47. build Mechanical Engineering
  48. perm_media Media & PR
  49. local_hospital Medical
  50. local_hospital Military & Public Safety
  51. local_hospital Mining
  52. medical_services Nursing
  53. local_gas_station Oil & Gas
  54. biotech Pharmaceutical
  55. checklist_rtl Project Management
  56. shopping_bag Purchasing
  57. home_work Real Estate
  58. person_search Recruitment Consultancy
  59. store Retail
  60. point_of_sale Sales
  61. science Scientific Research & Development
  62. wifi Telecoms
  63. psychology Therapy
  64. pets Veterinary
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