Hospice and Palliative Medicine Full-Time position in Houston, Texas

**Primary Responsibilities:** * Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorizations and denial reviews * Conduct peer to peer conversations for the clinical case reviews, as needed * Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care * Communicate effectively with network and non-network providers to ensure the successful administering of naviHealth’s services * Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers * Represent naviHealth on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders * Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers * Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals * Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees * Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting * Regularly meet with naviHealth’s leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues * Provide input on local needs for Analytics Team and Client Services Team to better enhance naviHealth’s products and services * Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME * Participate on the Medical Advisory Board * Providing intermittent, scheduled weekend and evening coverage * Perform other duties and responsibilities as required, assigned, or requested **Required Qualifications:** * Board certification as an MD, DO, MBBS with a current unrestricted license to practice and maintain necessary credentials to retain the position * Current, unrestricted medical license and the ability to obtain licensure in multiple states * 3+ years of post-residency patient care, preferably in inpatient or post-acute setting **Preferred Qualifications:** * Licensure in multiple states * Willing to obtain additional state licenses, with naviHealth’s support * Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care * Demonstrated ability to work within a team environment while completing multiple tasks simultaneously * Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision * Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals * Demonstrated competence in use of electronic health records as well as associated technology and applications * Proven excellent organizational, analytical, verbal and written communication skills * Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues * Proven highest level of ethics and integrity * Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment

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