New

Medical Director

Telligen
United States, Illinois, Chicago
Nov 27, 2024
The Medical Director is responsible for guiding the clinical aspects of Telligen's population health management programs and the clinical decision-making aspects of the assigned programs. You will have substantial individual responsibility for the performance of medical necessity reviews, including appeals and peer-to-peer reviews of assigned contracts. You will support Telligen in business development efforts that require advanced clinical subject matter expert involvement. Essential Functions Accountable for the accredited clinical service activities of the organization or assigned contracts. Conducts critical peer reviews to ensure health services given are appropriate and necessary. Serves as the medical expert with peer review and appeals processes. Works closely with assigned teams to meet critical timelines. Attends hearings either virtually or in person as required. Instructs other physicians and clinical support staff on clinical policy, process, and improvement of health care services. Supports Telligen in business development efforts. Advises on policy and develops clinical personnel as required to improve lives and economies where our clients live and work. Assists Telligen staff with training physicians and clinical support staff regarding their responsibilities and functions. Serves as a technical expert on the peer review and appeals processes. Represents Telligen policies and procedures to medical and non-medical persons. Participates in committee meetings representing the Company or as designated within assigned contracts. Performs miscellaneous duties as assigned. Requirements Current unrestricted clinical license to practice medicine. Current and active, unrestricted United States board certification by the American Board of Medical Specialties or Advisory Board of Osteopathic Medicine. Post-graduate experience in direct clinical patient care in a physical or behavioral health setting. Experience working with care management programs (health utilization management, case management, and/or disease management). Doctor of Internal Medicine preferred. Accreditation requirements may require the incumbent to maintain some degree of active practice. Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential. COMMITMENT TO SAFETY As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination) Who We Are: Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions. Our business is our people and we're looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us Are you Ready? We're on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity. Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win. Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other. Ingenuity: We're a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we're all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away! Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence. Thank you for your interest in Telligen! Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed. Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), and E-Verify Participants. Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. Telligen does not accept 3rd party solicitations from outside staffing firms.