Medical Consultant (Part-Time) position at Neighborhood Health Plan of RI in Providence

Neighborhood Health Plan of RI is in need of Medical Consultant (Part-Time) on Mon, 17 Jun 2013 18:59:20 GMT. The role of the Medical Consultant is to provide clinical support to the Director of Pharmacy, Associate Medical Directors, and Chief Medical Officer in providing clinical input to Medical Review, Expense Management, and Medical Management activities. Qualifications Required : - Physician, unrestricted license in the State of Rhode Island; no restrictions in any state - Board certified in a...

Medical Consultant (Part-Time)

Location: Providence Rhode Island

Description: Neighborhood Health Plan of RI is in need of Medical Consultant (Part-Time) right now, this position will be placed in Rhode Island. Further informations about this position opportunity kindly see the descriptions. The role of the Medical Consultant is to provide clinical support to the Director of Pharmacy, Associate Medical Directors, and Chief Medical Officer in providing clinic! al input to Medical Review, Expense Management, and Medical Management activities.

Qualifications

Required :

• Physician, unrestricted license in the State of Rhode Island; no restrictions in any state
• Board certified in a primary care or other relevant specialty
• Excellent analytical and communication skills

Preferred:

• Previous clinical practice and/or Health Plan experience
• Ongoing part-time clinical practice preferable

Duties and Responsibilities:
Responsibilities include, but are not limited to the following:

• Provide clinical expertise to the Medical Review process
• Performing review of medical and pharmacy requests for non-benefit or restricted benefit services
• Engaging providers in discussions of medical necessity
• Notifying members and providers of decisions
• Guiding development and application of Clinic! al Benefit Guidelines
• Participating as a member of th! e Clinical Management Committee
• Meeting all regulatory expectations of review processes
• Serve as clinical resource to Medical Management for
• Development and maintenance of Clinical Practice Guidelines
• Development of Clinical Medical Policies
• Clinical and disease management programs and
• Research and consultation as requested by nurse case managers
• Provide clinical expertise to the Quality Assurance process by performing review and recommendation for member and provider complaints, and participate as a member of the
• Quality Assurance Committee in decision for actionable follow-up to complaints
• Assist in preparation for regulatory and accreditation reviews
• At the direction of the Director of Pharmacy, represent Neighborhood in meetings or other forums with practitioners, regulators, purchasers, etc
• Comply with Neighborhood policies and procedures on Confidentiality
• Perfo! rm other duties as assigned by the Director of Pharmacy

Neighborhood is an EOE M/F/D/V and an E-Verify Employer .
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Neighborhood Health Plan of RI.

If you interested on this position just click on the Apply button, you will be redirected to the official website

This position starts available on: Mon, 17 Jun 2013 18:59:20 GMT

Apply Medical Consultant (Part-Time) Here