Corporate Medical Director, REMOTE
AF Group

Job Info

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Remote Opportunity. Must reside within the U.S.
Travel is required

SUMMARY:

Provide visionary and anticipatory guidance and leadership on changes in clinical management environments for both evidenced and non-evidenced based medicine in the practices of Worker's Compensation and Property and Casualty claims. Interpret and report on resulting impact of new technology, treatments, medications and products that could enhance or medical management strategies while also positioning us to provide specialized medical management strategies. Provide strategic direction to the organization around medical and disability management and treatment plans with a special focus on improving quality of care and access to care and while containing medical cost when possible. Conduct clinical liaison function to providers and program development on a national level. Utilize data analytics, predictive models and industry trends to develop medical programs focused on best in class. Provide insight and help create strategic and specialized medical claims solutions best suited for affecting optimal care and outcomes for those whom we owe a duty of care.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.:

• Owns and is responsible for specific strategic assignments focused on enterprise and/or individual operating unit needs that are focused on contributing to the development of a claim organization that provides a strategic advantage in the marketplace.
• Assists in the selection, education and ongoing evaluation of Care Analytics and PPO providers and maintains positive relationships as enterprise claims liaison to the medical community.
• Acts as medical consultant to the entire organization in such areas as medical and disability claim management and return to work programs.
• Assists in interpreting governmental regulatory matters relative to medical and disability management for effectiveness in the provision of services.
• Monitors and reports on changes in medical worker's compensation and Property & Casualty industry on a quarterly basis.
• As approved by the Company Executive leadership, represents the Company, Inc. in state and industry organizations, collaborating with corporate claims and operating units in the development of enterprise claims strategies around proposed and enacted regulatory changes.
• Provides expertise on review of data and reports to assist in developing and improving medical management strategies.
• Review claims and evaluate the appropriateness and cost-effectiveness of medical treatment and services
• Service as a resource and provide training to non-clinical associates
• Develops effective Medical Policies and Procedures around the administration of Enterprise Claims Outcome strategies such as surgical, diagnostic and other medical treatment; create and maintain database of policies and procedures for same.
• Provides Medical guidance on evaluation and selection of medical support tools such as UR software, IME software and medical treatment guidelines.
• As approved by the Company Claims leadership, provides consultative reviews on claim by claim basis where needed.
• Develops and implements written policies focused upon appropriate use of cost containment programs such as utilization review and durable medical equipment, for examples.
• Develop cost containment strategy including medical education activity by nurses, overseeing credentials of medical personnel, assisting with regulatory compliance.
• Represent AF Group Insurance Company in a positive fashion to the community, locally and nationally.
• Report on status of clinical programs and their use to organization leadership. Support executive level positions with medical expertise as needed.
• Maintain positive communication to provider community.
• Represent the Company. on external committees and advisory boards as requested and approved. Works to develop research or white papers to promote to the claims department on emerging medical trends within the workers' compensation and health care systems, impacting claim outcomes.
• As approved by the Company Executive leadership, acts as the Enterprise's medical subject matter expert presenting at national workers' compensation and disability conferences, as well as at national industry associations.

EDUCATION AND EXPERIENCE:

• Medical degree (M.D., D.O.) required.
• Must possess license to practice medicine and obtain completion of Board Certification.
• Ten (10) years in insurance administration or other relevant experience which provides the necessary skills, knowledge and abilities.
• Experience in the areas of managed care, utilization review and occupational disability is highly desired.
• Five (5) years of Leadership experience.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES:

• Extensive knowledge of workers compensation laws, regulatory authorities, compliance requirements, industry trends and their impact.
• Ability to create and articulate a clear strategic vision for medical and disability management.
• Ability to make decisions or recommendations significantly changing, interpreting or developing important policies or programs.
• Ability to effectively exchange information clearly and concisely and to present ideas, report facts and other information and respond to questions as appropriate.
• Candidate must possess strong organizational skills and be able to operate in a team environment.
• Demonstrate leadership abilities.
• Extensive knowledge of medical and legal terminology.
• Excellent verbal and written communication skills are essential.
• Must be results-oriented and be motivated to creatively problem solve.

OTHER SKILLS AND ABILITIES:

• Extensive knowledge of workers compensation laws, regulatory authorities, compliance requirements, industry trends and their impact.
• Ability to create and articulate a clear strategic vision for medical and disability management.
• Ability to make decisions or recommendations significantly changing, interpreting or developing important policies or programs.
• Ability to effectively exchange information clearly and concisely and to present ideas, report facts and other information and respond to questions as appropriate.
• Candidate must possess strong organizational skills and be able to operate in a team environment.
• Demonstrate leadership abilities.
• Extensive knowledge of medical and legal terminology.
• Excellent verbal and written communication skills are essential.
• Must be results-oriented and be motivated to creatively problem solve.

SUPERVISORY RESPONSIBILITIES

Directly supervises a varied number of employees in the designated department(s). Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

ADDITIONAL INFORMATION

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.

WORKING CONDITIONS

Work is performed in an office/remote setting with no unusual hazards. Travel required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

Pay Range: "Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $187,500 and $314,000."

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

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