118 Lahey Hospital Medical Center jobs in Peabody
Major Gifts Officer- Lahey Hospital & Medical Center
Posted 10 days ago
Job Viewed
Job Description
When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.
Major Gifts OfficerThe Major Gifts Officer is primarily responsible for the identification, cultivation, and solicitation of individual major gift prospects and donors in a healthcare environment. Serves as a member of the philanthropy team and plays a central role in developing, overseeing, and managing major gift strategies and programs, and relating them to other segments of the department's advancement efforts, in coordination with the Major Gifts staff. An advocate for the mission and programs of the network and institution, represents the institution among its volunteer leadership and key and influential public audiences as a frontline fundraiser.
Essential Responsibilities- Serves as a member of the department's staff with responsibility for advancing the institution's major gifts program to successfully: identify, cultivate, solicit, and steward major gift prospects and donors. Particular attention will be given to high-end annual fund donors who have the capacity to become major gifts prospects.
- Builds and manages a personal portfolio of major gift prospects and donors that comprise many of the institution's most important and sensitive relationships; works in consultation with unit leadership, colleagues on the Major Gifts team and keyboard and other volunteer leaders to discuss and devise individually tailored major gift strategies.
- Works to foster an atmosphere, internally and externally, of widespread cooperation and ownership to reinforce a common sense of purpose and establish an ever-increasing understanding and comfort with the development plans, and strategies designed to achieve institutionally supported objectives.
- Shares responsibility for the strategic planning, development, and implementation of the division's goals in collaboration with others as necessary.
- Shapes key institutional and philanthropy-related messages through the direction and preparation of proposals, solicitation letters, and other materials for major prospects and donors; ensures that they are persuasively communicated to key and target audiences and are consistent with the efforts of others to strategically position the institution in the marketplace.
- Establishes and maintains high-quality relationships with the institutions' department chairs, division chiefs, physicians and researchers, and other key staff by establishing a personal rapport and acquiring and demonstrating a firm grasp of a wide range of medically related terms and critical issues facing the health care profession.
- Collaborates with the members of the Philanthropy Office to plan prospect management strategies and steps that are coordinated and place the prospect's best interests first.
- Participates in the preparation of an annual operating plan for the division, which includes a complete review of the year's activities and sets specific goals and objectives for the next and future fiscal years.
- Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.
- Bachelor's degree required.
- 3-5 years related work experience required.
- Ability to travel locally/regionally as prospect relationship building requires face-to-face, phone and written contact.
- Must demonstrate teamwork, resourcefulness, results orientation, optimism, and trust.
- Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.
- Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
- Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
- Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
- Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
- Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
- Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
- Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
- Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.
Join Our TeamMore than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
Equal Opportunity Employer/Veterans/DisabledMajor Gifts Officer- Lahey Hospital & Medical Center
Posted 12 days ago
Job Viewed
Job Description
When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.**This position will be based out of Burlington, MA, and will operate on a hybrid schedule**The Major Gifts Officer is primarily responsible for the identification, cultivation, and solicitation of individual major gift prospects and donors in a healthcare environment. Serves as a member of the philanthropy team and plays a central role in developing, overseeing, and managing major gift strategies and programs, and relating them to other segments of the department's advancement efforts, in coordination with the Major Gifts staff. An advocate for the mission and programs of the network and institution, represents the institution among its volunteer leadership and key and influential public audiences as a frontline fundraiser.Job Description:Essential Responsibilities: 1. Serves as a member of the department's staff with responsibility for advancing the institution's major gifts program to successfully: identify, cultivate, solicit, and steward major gift prospects and donors. Particular attention will be given to high-end annual fund donors who have the capacity to become major gifts prospects.2. Builds and manages a personal portfolio of major gift prospects and donors that comprise many of the institution's most important and sensitive relationships; works in consultation with unit leadership, colleagues on the Major Gifts team and keyboard and other volunteer leaders to discuss and devise individually tailored major gift strategies.3. Works to foster an atmosphere, internally and externally, of widespread cooperation and ownership to reinforce a common sense of purpose and establish an ever-increasing understanding and comfort with the development plans, and strategies designed to achieve institutionally supported objectives.4. Shares responsibility for the strategic planning, development, and implementation of the division's goals in collaboration with others as necessary.5. Shapes key institutional and philanthropy-related messages through the direction and preparation of proposals, solicitation letters, and other materials for major prospects and donors; ensures that they are persuasively communicated to key and target audiences and are consistent with the efforts of others to strategically position the institution in the marketplace.6. Establishes and maintains high-quality relationships with the institutions' department chairs, division chiefs, physicians and researchers, and other key staff by establishing a personal rapport and acquiring and demonstrating a firm grasp of a wide range of medically related terms and critical issues facing the health care profession.7. Collaborates with the members of the Philanthropy Office to plan prospect management strategies and steps that are coordinated and place the prospect's best interests first.8. Participates in the preparation of an annual operating plan for the division, which includes a complete review of the year's activities and sets specific goals and objectives for the next and future fiscal years.Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.Job Requirements:1. Bachelor's degree required.2. 3-5 years related work experience required.3. Ability to travel locally/regionally as prospect relationship building requires face-to-face, phone and written contact.4. Must demonstrate teamwork, resourcefulness, results orientation, optimism, and trust.5. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.Competencies:•Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.•Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.•Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.•Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.•Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.•Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.•Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.•Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner.As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement.More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.Equal Opportunity Employer/Veterans/Disabled
Physician Hospitalist - Lahey Hospital and Medical Center (Burlington)
Posted 12 days ago
Job Viewed
Job Description
Job Type: Regular
Time Type: Full time
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.
Job Description:
The Division of Hospital Medicine at Beth Israel Lahey Health is actively recruiting staff hospitalists for its affiliated site at Lahey Hospital and Medical Center. Beth Israel Lahey Health is a progressive and highly regarded integrated healthcare system offering a continuum of care that includes three Truven Health Analytics top 100 hospitals: Lahey Hospital & Medical Center, a renowned 335-bed, Tufts-affiliated Teaching Hospital; Beverly Hospital, recognized by Blue Cross and Blue Shield for two years running as the top quality hospital in all of Massachusetts; and Winchester Hospital, perennially voted the top hospital to work for in all of Massachusetts.
Day and night time Hospitalist Opportunities currently available at Lahey Hospital and Medical Center
The Department of Hospital Medicine at Beth Israel Lahey Health is actively seeking hospitalists interested in a full time position. Day and night time positions are currently available. The Department is comprised of more than 60 FTE physicians and approximately 10 advance practitioners, all committed to providing exceptional patient care. The Group employs a hybrid schedule which includes the traditional 7 on, 7 off block schedule and regular day schedule. Although there are no hard caps, patient volume typically falls within SHM recommended ranges. The Department of Hospital Medicine is a democratically run, collegial group where providers feel their contributions are recognized and valued.
Ideal candidates should possess strong academic credentials including Residency Training in Internal Medicine or Family Medicine.
Candidates should be committed to providing exceptional patient care. They should be hard-working, dependable, collegial and professional in their demeanor. As is the case with our current providers, they should be true team players.
Chosen candidates will receive a highly competitive salary along with a comprehensive benefits package. Beth Israel Lahey Health will also provide reimbursement for interview related expenses and relocation support. We will assist candidates with licensing, visa issues, credentialing and all other on-boarding related matters.
To learn more about Beth Israel Lahey Health visit: . To learn more about our Hospitalist Opportunities, please contact:
Ellen Haggerty
Physician Recruiter
Beth Israel Lahey Health
Burlington, MA 01805
Email:
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled #J-18808-Ljbffr**Physician Hospitalist - Lahey Hospital and Medical Center (Burlington) (Burlington)
Posted 12 days ago
Job Viewed
Job Description
Job Type: Regular
Time Type: Full time
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.
**Physician Hospitalist - Lahey Hospital and Medical Center (Burlington)Job Description:
The Division of Hospital Medicine at Beth Israel Lahey Health is actively recruiting staff hospitalists for its affiliated site at Lahey Hospital and Medical Center. Beth Israel Lahey Health is a progressive and highly regarded integrated healthcare system offering a continuum of care that includes three Truven Health Analytics top 100 hospitals: Lahey Hospital & Medical Center, a renowned 335-bed, Tufts-affiliated Teaching Hospital; Beverly Hospital, recognized by Blue Cross and Blue Shield for two years running as the top quality hospital in all of Massachusetts; and Winchester Hospital, perennially voted the top hospital to work for in all of Massachusetts.
Day and night time Hospitalist Opportunities currently available at Lahey Hospital and Medical Center The Department of Hospital Medicine at Beth Israel Lahey Health is actively seeking hospitalists interested in a full time position. Day and night time positions are currently available.
The Department is comprised of more than 60 FTE physicians and approximately 10 advance practitioners, all committed to providing exceptional patient care. The Group employs a hybrid schedule which includes the traditional 7 on, 7 off block schedule and regular day schedule. Although there are no hard caps, patient volume typically falls within SHM recommended ranges.
The Department of Hospital Medicine is a democratically run, collegial group where providers feel their contributions are recognized and valued. Ideal candidates should possess strong academic credentials including Residency Training in Internal Medicine or Family Medicine. Candidates should be committed to providing exceptional patient care. They should be hard-working, dependable, collegial and professional in their demeanor. As is the case with our current providers, they should be true team players.
Chosen candidates will receive a highly competitive salary along with a comprehensive benefits package. Beth Israel Lahey Health will also provide reimbursement for interview related expenses and relocation support.
We will assist candidates with licensing, visa issues, credentialing and all other on-boarding related matters.To learn more about Beth Israel Lahey Health visit:
To learn more about our Hospitalist Opportunities, please contact:
Ellen Haggerty
Physician Recruiter
Beth Israel Lahey Health
Burlington, MA 01805
Email:
Diversity is a core value at Beth Israel Lahey Health. We are passionate about building and sustaining an inclusive and equitable working and learning environment for our staff. We believe every member on our team enriches our diversity by exposing us to a broad range of ways to understand and engage with the world, identify challenges, and to discover, design and deliver solutions.
Physician Hospitalist - Lahey Hospital and Medical Center (Burlington MA) (Burlington)
Posted 12 days ago
Job Viewed
Job Description
Job Type: Regular
Time Type: Full time
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.
Physician HospitalistJob Description:
The Division of Hospital Medicine at Beth Israel Lahey Health is actively recruiting staff hospitalists for its affiliated site at Lahey Hospital and Medical Center. Beth Israel Lahey Health is a progressive and highly regarded integrated healthcare system offering a continuum of care that includes three Truven Health Analytics top 100 hospitals: Lahey Hospital & Medical Center, a renowned 335-bed, Tufts-affiliated Teaching Hospital; Beverly Hospital, recognized by Blue Cross and Blue Shield for two years running as the top quality hospital in all of Massachusetts; and Winchester Hospital, perennially voted the top hospital to work for in all of Massachusetts.
Day and night time Hospitalist Opportunities currently available at Lahey Hospital and Medical Center
The Department of Hospital Medicine at Beth Israel Lahey Health is actively seeking hospitalists interested in a full time position. Day and night time positions are currently available. The Department is comprised of more than 60 FTE physicians and approximately 10 advance practitioners, all committed to providing exceptional patient care. The Group employs a hybrid schedule which includes the traditional 7 on, 7 off block schedule and regular day schedule. Although there are no hard caps, patient volume typically falls within SHM recommended ranges. The Department of Hospital Medicine is a democratically run, collegial group where providers feel their contributions are recognized and valued.
Ideal candidates should possess strong academic credentials including Residency Training in Internal Medicine or Family Medicine. Candidates should be committed to providing exceptional patient care. They should be hard-working, dependable, collegial and professional in their demeanor. As is the case with our current providers, they should be true team players.
Chosen candidates will receive a highly competitive salary along with a comprehensive benefits package. Beth Israel Lahey Health will also provide reimbursement for interview related expenses and relocation support. We will assist candidates with licensing, visa issues, credentialing and all other onboarding related matters.
To learn more about Beth Israel Lahey Health visit: . To learn more about our Hospitalist Opportunities, please contact:
Ellen Haggerty
Physician Recruiter
Beth Israel Lahey Health
Burlington, MA 01805
Email:
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled #J-18808-LjbffrPhysician Hospitalist - Lahey Hospital and Medical Center (Burlington MA) (Burlington)
Posted 12 days ago
Job Viewed
Job Description
Job Type: Regular
Time Type: Full time
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.
Physician HospitalistJob Description:
The Division of Hospital Medicine at Beth Israel Lahey Health is actively recruiting staff hospitalists for its affiliated site at Lahey Hospital and Medical Center. Beth Israel Lahey Health is a progressive and highly regarded integrated healthcare system offering a continuum of care that includes three Truven Health Analytics top 100 hospitals: Lahey Hospital & Medical Center, a renowned 335-bed, Tufts-affiliated Teaching Hospital; Beverly Hospital, recognized by Blue Cross and Blue Shield for two years running as the top quality hospital in all of Massachusetts; and Winchester Hospital, perennially voted the top hospital to work for in all of Massachusetts.
Day and night time Hospitalist Opportunities currently available at Lahey Hospital and Medical Center
The Department of Hospital Medicine at Beth Israel Lahey Health is actively seeking hospitalists interested in a full time position. Day and night time positions are currently available. The Department is comprised of more than 60 FTE physicians and approximately 10 advance practitioners, all committed to providing exceptional patient care. The Group employs a hybrid schedule which includes the traditional 7 on, 7 off block schedule and regular day schedule. Although there are no hard caps, patient volume typically falls within SHM recommended ranges. The Department of Hospital Medicine is a democratically run, collegial group where providers feel their contributions are recognized and valued.
Ideal candidates should possess strong academic credentials including Residency Training in Internal Medicine or Family Medicine. Candidates should be committed to providing exceptional patient care. They should be hard-working, dependable, collegial and professional in their demeanor. As is the case with our current providers, they should be true team players
Chosen candidates will receive a highly competitive salary along with a comprehensive benefits package. Beth Israel Lahey Health will also provide reimbursement for interview related expenses and relocation support. We will assist candidates with licensing, visa issues, credentialing and all other on-boarding related matters.
To learn more about Beth Israel Lahey Health visit: . To learn more about our Hospitalist Opportunities, please contact:
Ellen Haggerty
Physician Recruiter
Beth Israel Lahey Health
Burlington, MA 01805
Email:
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled #J-18808-LjbffrPhysician Hospitalist - Lahey Hospital and Medical Center (Burlington, MA) (Burlington)
Posted 12 days ago
Job Viewed
Job Description
Job Type: Regular
Time Type: Full time
Work Shift: Day (United States of America)
FLSA Status: Exempt
When you join the growing BILH team, you're not just taking a job, youre making a difference in peoples lives.
Physician HospitalistJob Description:
The Division of Hospital Medicine at Beth Israel Lahey Health is actively recruiting staff hospitalists for its affiliated site at Lahey Hospital and Medical Center. Beth Israel Lahey Health is a progressive and highly regarded integrated healthcare system offering a continuum of care that includes three Truven Health Analytics top 100 hospitals: Lahey Hospital & Medical Center, a renowned 335-bed, Tufts-affiliated Teaching Hospital; Beverly Hospital, recognized by Blue Cross and Blue Shield for two years running as the top quality hospital in all of Massachusetts; and Winchester Hospital, perennially voted the top hospital to work for in all of Massachusetts.
Day and night time Hospitalist Opportunities currently available at Lahey Hospital and Medical Center The Department of Hospital Medicine at Beth Israel Lahey Health is actively seeking hospitalists interested in a full time position.
The Department is comprised of more than 60 FTE physicians and approximately 10 advance practitioners, all committed to providing exceptional patient care. The Group employs a hybrid schedule which includes the traditional 7 on, 7 off block schedule and regular day schedule. Although there are no hard caps, patient volume typically falls within SHM recommended ranges.
The Department of Hospital Medicine is a democratically run, collegial group where providers feel their contributions are recognized and valued. Ideal candidates should possess strong academic credentials including Residency Training in Internal Medicine or Family Medicine. Candidates should be committed to providing exceptional patient care. They should be hard-working, dependable, collegial and professional in their demeanor. As is the case with our current providers, they should be true team players.
Chosen candidates will receive a highly competitive salary along with a comprehensive benefits package. Beth Israel Lahey Health will also provide reimbursement for interview related expenses and relocation support.
We will assist candidates with licensing, visa issues, credentialing and all other on-boarding related matters.
To learn more about Beth Israel Lahey Health visit:
To learn more about our Hospitalist Opportunities, please contact:
Ellen Haggerty
Physician Recruiter
Beth Israel Lahey Health
Burlington, MA 01805
Email:
Diversity is a core value at Beth Israel Lahey Health. We are passionate about building and sustaining an inclusive and equitable working and learning environment for our staff. We believe every member on our team enriches our diversity by exposing us to a broad range of ways to understand and engage with the world, identify challenges, and to discover, design and deliver solutions.
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled #J-18808-LjbffrBe The First To Know
About the latest Lahey hospital medical center Jobs in Peabody !
Medical Director, Clinical Services
Posted today
Job Viewed
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.
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
Medical Director, Clinical Services
Posted 22 days ago
Job Viewed
Job Description
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.
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Req ID: J267780
Clinical Services Manager, Elderly Care
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