Medical Director - ID Hospice Medical Review - Contract ?
Job Location Boise, ID
Position Type Full-Time/Regular
Qlarant is a not-for-profit corporation that partners with
public and private sectors to create high quality, safe, and
efficient delivery of health care and human services programs. We
have multiple lines of business including population health,
utilization review, managed care organization quality review, and
quality assurance for programs serving individuals with
developmental disabilities. Qlarant is also a national leader in
fighting fraud, waste and abuse for large organizations across the
country. In addition, our Foundation provides grant opportunities
to those with programs for under-served communities.
Qlarant has a home-based contract opportunity for a physician
with experience providing hospice services. In this role, you
will perform reviews of medical records and related
documentation for medical necessity. In addition, this position
supports review determinations during the appeals process including
depositions and court testimony. It is preferred that the selected
physician is located in Idaho, but other states are acceptable.
Please note: This is a contractual arrangement with an hourly
rate. There are no guaranteed hours as the work is assigned on an
as needed basis.
This position supports our Unified Program Integrity Contract
(UPIC) team's efforts to identify and investigate the fraud, waste
and abuse (FWA) impacting our nation's Medicare and Medicaid
programs. Our Cerritos-based UPIC West team is responsible for
FWA investigations covering 16 Western states and
While medical review and support of review determinations will
be the primary responsibilities of this position, the Medical
Director job description includes the following essential duties
and responsibilities. Other duties may be assigned.
Provides clinical information to teams
Medical Review Oversight may include:
Physician peer review activities
Criteria development and assessment
Correspondence regarding review determination
Recruitment, credentialing, and training of expert physician
Managing the expert physician advisory network in specific
Serving on external committees
Professional Relations may include:
Interfacing with external organizations including physician
specialty groups, hospital associations, medical societies,
affiliates contractors, and state and federal agencies
Discussing specific clinical issues with attending
Health Care Quality Improvement/Assurance may include:
Leading and/or participates in quality improvement projects as
Providing clinical input to specific projects as required by the
organization or contractors
Supporting project managers or teams with specific collaborative
projects as needed
Maintaining working knowledge of current quality improvement
issues and tools
Required Skills To perform the job successfully, an individual
should demonstrate the following competencies:
Analytical - Synthesizes complex or diverse information;
Collects and researches data; Uses experience to complement
Quality Management - Looks for ways to improve and promote
Business Acumen - Understands business implications of
decisions; Demonstrates knowledge of market and competition; Aligns
work with strategic goals; Contributes to the development of
responses to Requests for Proposals.
Communication – Utilizes established protocols to communicate in
an effective and timely manner with coach, project staff, and
Judgment - Displays willingness to make decisions; Exhibits
sound and accurate judgment; Supports and explains reasoning for
decisions; Includes appropriate people in decision-making process;
Makes timely decisions.
Design - Generates creative solutions; Translates concepts and
information into images; Uses feedback to modify designs; Applies
design principles; Demonstrates attention to detail.
Teamwork - Balances team and individual responsibilities;
Exhibits objectivity and openness to others' views; Gives and
welcomes feedback; Contributes to building a positive team spirit;
Puts success of team above own interests; able to build morale and
group commitments to goals and objectives; Supports everyone's
efforts to succeed.
Customer Service - Manages difficult or emotional customer
situations; Responds promptly to customer needs; Solicits customer
feedback to improve service; Responds to requests for service and
assistance; Meets commitments.
Problem Solving - Identifies and resolves problems in a timely
manner; Gathers and analyzes information skillfully; Develops
alternative solutions; Works well in group problem solving
situations; Uses reason even when dealing with emotional
Planning/Organizing - Prioritizes and plans work activities;
Sets goals and objectives; Completes work within required
Organizational Support - Supports organization's goals and
values; Benefits organization through outside activities.
Other Skills and Abilities:
Uses knowledge and experience to interpret medical polices and
guidelines. Complies with specific contract requirements.
To perform this job successfully, an individual should have
knowledge of Word Processing software.
Must have basic understanding of the use of the computer.
Required Experience Education and/or Experience:
Doctoral degree (MD) with at least 5 years Hospice services
clinical experience with a focus on quality improvement and/or
quality assurance. Hospice services experience must be current or
within the past 5 years.
Advanced degree in public health or health care administration
preferred. May consider an equivalent combination of education and
Board Certification in Hospice required.
Knowledge of Medicare/Medicaid required.
Previous experience as a medical reviewer strongly
Must be willing and able to support review determinations during
the appeals process including depositions and court testimony.
Microsoft Office proficiency at a level that allows timely
completion of deliverables.
Certificates, Licenses, Registrations: Valid, current, active,
and unrestricted clinical physician license and practice as a
health professional in a state or territory of the United
Travel Requirements: Travel requirements vary based on contract
requirements may require periodic overnight and/or local travel.
Must be willing to travel in accordance with company and contract
Qlarant is an Equal Opportunity Employer of Minorities, Females,
Protected Veterans, and Individuals with Disabilities.