Medical Officer - Health Plan

Job Title: Medical Officer | Health Plan | Sioux Falls

City: Sioux Falls

State: South Dakota

Department *: * Health Plan

Job Schedule: Part Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

Serves as Medical Officer for Sanford Health Plan. Provides clinical based knowledge and skillset in applying the Plans determination of medical necessity to the the first level prior authorizations as well as potential second level appeal. Assists in the development of medical policy and clinical analysis of data, practice patterns, protocols and the strategic goals of the Sanford Health plan as well as assisting in the analysis to maintain high quality services and cost efficiency.

POSITION RESPONSIBILITIES

A Medical Officer for Medical Services for the Health Plan must have knowledge of first level review on prior authorization services. Must be able to have peer-to-peer review requests. Must have experience in medical review and due diligence to assist the CMO office in educating on quality, safety, fraud and abuse. Must be able to facilitate/assist care management teams in the review process intent on helping our members with appropriate use of medical services. Provides clinical expertise needed to effectively and efficiently resolve complex administrative circumstances. Must have strong facilitation, problem solving and conflict resolutions skills. Must have strong oral and written communication skills. Must demonstrate knowledge of the principles and practices of managed care related to utilization management and/or case management and /or discharge planning.

QUALIFICATIONS

Board certification Administrative licensed in State of SD, ND. MD/DO degree is requisite. Experience in Quality Management in a healthcare setting is preferred.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-243-1372 or send an email to talent@sanfordhealth.org .
In compliance with federal law requiring employers to verify new employees' U.S. employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .

City: Sioux Falls

State: South Dakota

Job Function: Health Plan

Job Schedule: Part Time

Shift: Days

Req Number: req20416