Reporting to the Director, Managed Care, the National Medical Director is the top physician in the Commercial Insurance Claims organization. Manages the day-to-day activities of Regional Medical Directors; oversee medical aspects of utilization management; clinical resource tools; strategic planning and policy development involving managed care; development and supervision of the internal medical education program.
Watch: Career Advice
Provide oversight of all internal physician review services provided on Liberty Mutual (LM) claims.
Provides medical oversight of the utilization management program. Is responsible for the clinical aspects of the program and has periodic consultation with practitioners in the field
Develop and maintain medical guidelines and medical policies for Commercial Insurance.
Ensure medical accuracy and quality of medical services provided to LM by outside vendors, including but not limited to Internal Medical Evaluation (IME) and peer review services.
Reviews industry standards and protocols for treatment programs.
Makes recommendations and coordinates efforts with vendors to change/modify standards/protocols based upon clinical experience and knowledge.
Monitors vendor performance and develops guidelines to evaluate vendor quality
Provide oversight/review of clinical content for LM training programs and medical training curriculum.
Participate in and provide medical advice to LM committees with various missions, and task forces relating to specific issues/problems.
Serve as a medical resource for a variety of activities at Liberty Mutual, including Legal, Public Affairs, Loss Prevention and Sales & Marketing.
Qualifications:
Practicing Physician (MD or DO) with current U.S. and state license.
Board certification, should have primary care specialty and/or sub-specialty relevant to occupational medicine (for example occupational medicine, internal medicine, family practice, general surgery, orthopedic surgery or psychiatry) with at least five years of clinical practice experience.
At least 1 year of medical review experience with workplace issues, short and long-term disability, and workers compensation.
Knowledge of utilization management process and/or insurance medicine as normally acquired through experience in managing physicians in a managed care and/or disability environment.
Send To A Friend
Posts
