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

Description

**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