Leading Risk-Bearing, Value-Based Home Care Services Provider and Post-Acute Care Management Company
Mission: Provide all the services and technology required to enable patients to remain in their home through a fully-integrated model across three core lines of service – homecare, home medical equipment (“DME/HME”) and home infusion / pharmacy – while also matching patients to the right site of care.
Primary responsible physician for fulfilling health plan contract case review requirements, which includes:
Review of cases sent for Second Level Review
UM and Case Management ( Peer to Peer reviews, establishing and implementing/using nationally recognized guidelines (i.e. IQ, Milliman)
Identifying trends, as well as anomalies, research errors, unauthorized or non-covered services to improve accuracy in delivery of covered services, reduce overutilization, costs and improve outcomes
UM oversight and excellence
Tracking performance (clinical and financial outcomes) make recommendations and discuss with health plan clients
Deep clinical understanding of the HomeCare Solutions To Disseminate Benefits to Clients
Assisting in Network Development and Maintain Relationships with Plan and MSO Clinical Leadership, medical directors, medical associations, hospitals, health systems, and regulatory bodies
Supporting audit and compliance requirements of regulatory bodies and customers
Design innovative clinical and quality programs, Home Care programs, work with industry leaders and grow professionally and within the company.
Medical Doctor or Doctor of Osteopathy
Board Certification or Equivalent in IM, Geriatrics, Emergency Medicine,, Rehab or Family Practice Preferred
5 Years Clinical Practice of Adult Patients
Active FL License or Ability to Obtain
Home Based Services , SNF Post Acute preferred
Health Plan Quality , UM, Peer to Peer , Population Health, Chronic Care Mgt. Preferred
Diplomatic, Collaborative Communication and Listening Skills
Employer will assist with relocation costs.
Additional Salary Information: Bonus and rich benefits offered
Internal Number: 010
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