Medical Director As the Massachusetts Medical Director, you will be responsible for providing guidance on the clinical aspects of the utilization management program of Telligen and is responsible for the clinical decision-making aspects of the care management programs. You may perform medical necessity reviews, including appeals and peer-to-peer conference calls.
This role is contingent upon award. In this role, you will: Oversee and have accountability for the medical review activities of the organization or assigned contracts.Conduct critical peer reviews to ensure the care given is appropriate and necessary.Instruct other physician reviewers on critical reviews and improvement of health care.Assist Telligen staff with training physician reviewers regarding their responsibilities and functions.Serve as a technical expert on the peer review process.Represent Telligen policies and procedures to medical and non-medical persons.Participate in committee meetings representing the Company.What You'll Need: Current unrestricted clinical license to practice medicine in Massachusetts.Current and active, unrestricted United States board certification by the American Board of Medical Specialties or Advisory Board of Osteopathic Medicine.3 years of experience working with Medicaid-specific utilization review and quality improvement.The Medical Director may not serve in any role in a hospital setting while employed with Telligen.Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential.We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories. 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.
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