Einstein Healthcare Network is a private, not-for-profit organization with several major facilities and many outpatient centers. Our primary mission is to provide compassionate, high-quality healthcare to the greater Philadelphia region. We are looking for an experienced Medical Director to join our Care Management team! Responsibilities include:
Serving as a Physician Advisor for inpatient and Emergency Department patients.
Communicating with physicians (verbally and in writing) when patients are not meeting InterQual criteria or when a denial has been received from a third-party payer.
Performing concurrent appeals with medical directors of insurance companies on the day of denial following the care manager's efforts to have a denial overturned.
Documenting same in SoftMed.
Licensed, board-certified physician, preferably in a primary care discipline.
M.D. or D.O. license required.
Knowledge of managed care and have functioned in a medical director role focused on care management for a minimum of 5 years.
Demonstrated a very clear track record of educating and motivating physicians to modify practice pattern behavior.
Credible clinician as evidenced by having had an active clinic practice, either currently or in the near past.