Job ID: J114321
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jan 5, 2018
JOB SUMMARY (Summarizes the major purpose and primary responsibilities)
This job is accountable for the strategic direction, implementation and effective execution of physician-led functions within Clinical Services including, but not limited to, Utilization Review, Medical Policy, Member and Provider Appeals and Retrospective Review. In addition this leader will have oversight of all Medical Director activities within Clinical Services especially those related to utilization management decision making with the intent of ensuring the delivery of high quality, cost effective, evidence-based care to the Organization's members across all products and markets.
ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)
Doctorate Degree - Medicine
Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience = 1 year college)
MD or DO
Master's Degree -
Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job. Minimum requirements must be non-comparative, objective, and relevant.
Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.
KNOWLEDGE, SKILLS & ABILITIES (List the attributes required to perform the job through demonstrated service, education or training)
REQUIRED LICENSURE (Licenses that are required to perform the job)
Board Certified Physician with Unrestricted Medical License in the state of PA
TRAVEL REQUIREMENT: 0% - 25%
(List % of time traveling)
LANGUAGE REQUIREMENT (other than English)?
(List primary language)
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
(The physical, mental demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential function of their job. Reasonable accommodations will be made when necessary to enable individuals with disabilities to perform the essential duties of the position, to the extent that they do not cause undue hardship.
An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
Teaches/Trains others regularly Frequently
Travels regularly from the office to various work sites or from site-to-site Occasionally
Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply
Physical Work Site Required True
Most On-The-Road Positions
An employee in this position may work in a home or company office environment but is also frequently driving to and from various locations to perform the work off-site. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.
An employee in this position is frequently required to move throughout the workplace, sit, stand and walk, use hands and fingers to hold objects, tools or controls, possess fine motor skills (e.g., to write and operate a computer or to steer transportation equipment), possess gross motor skills (e.g., to carry items), reach with hands and arms, climb stairs and ladders, balance, stoop, kneel crouch and crawl, communicate effectively, and talk and hear. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. The employee must be able to work in a busy environment where decisions often must be made quickly, must attend work on a regular and reliable basis, must adhere to all workplace policies, and may be called upon to work outside regular business hours. This work occurs in a [example: warehouse, hospital or provider’s office or mailroom].
Lifting: up to 10 pounds Occasionally
Lifting: 10 to 25 pounds Rarely
Lifting: 25 to 50 pounds Never
Changes Approved By:
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org