Medical Policy Specialist jobs in Moline, IL

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Company Overview

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation.

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team

Theoria Medical is seeking dedicated physicians to join its team to serve as medical directors and attending physicians at the skilled nursing facilities it manages. We have a wide variety of roles available suited for physicians in various stages of their careers with flexible scheduling in a positive work environment.

Shift Structure

• Shifts are flexible depending on physicians’ schedule;
• Typically, medical directors work a minimum of 2-3 days/week at each facility they oversee;
• Rounding times are flexible with no set start and end time. Preferably, physicians start in the morning between 7-10 a.m. and finish their day when their caseload has been seen;
• No nights or weekends
• Call is covered by Theoria’s telemedicine team
• This is an in-person position

Employment Type

• Full-Time, Part-Time, and PRN Assignments Available

Compensation and Benefits

• Competitive compensation package; wRVU productivity (no cap!) fixed monthly stipends.
• Compensation ranges approximately from $50,000-$400,000/year depending upon employment status and availability (PRN, Part-Time, Full-Time)
• Employer Paid - Life Insurance Policy

Full Time Providers

• $1,500 CME allowance
• All equipment and practice expenses covered by employer
• Medical licensure expenses reimbursed by employer
• Malpractice insurance covered by employer
• 401k with employer matching and participation
• Medical, vision, and dental insurance
• Short term and long term disability insurance

Part Time Providers

• Equipment may be provided (dependent upon # of shifts)
• All practice expenses covered by employer
• Malpractice insurance covered by employer

PRN Providers

• Equipment not provided (unless otherwise approved)
• All practice expenses covered by employer
• Malpractice insurance covered by employer

Essential Functions & Responsibilities

• The physician serves as medical director for skilled nursing facilities (SNF) and participates in administrative and quality initiatives for the facilities he or she is responsible for;
• Medical directorship functions include attending and participating in monthly quality assurance and process improvement meetings; participating in quality improvement initiatives; providing guidance to facility staff; overseeing clinical care plans; reviewing and revising (if necessary) facility’s clinical guidelines; insuring compliance with state and federal regulations, training facility staff; and supervising facility clinical staff.
• In addition to the medical director role, the physician also serves as the attending physician for the residents residing at each facility;
• The physician collaborates with Nurse Practitioners and Physician Assistants to manage day to day resident care at each facility. Typically, each facility will have a full-time PA or NP assigned to the facility depending on the acuity and volume of the patient population;
• Physician will provide high quality, patient-centered, comprehensive primary care services by rounding on patients residing in SNFs;
• Physician is responsible for diagnosing and treating patients with acute illness, such as bacterial and viral infections, as well as chronic diseases and conditions, such as hypertension, heart disease, or diabetes
• Provider documentation is completed in Theoria’s proprietary electronic health record (EHR) system, ChartEasy™
• PointClickCare, MatrixCare, and American HealthTech are the most commonly used facility EHR systems
• Participating in Theoria’s Chronic Care Management, Transitional Care, Remote Patient Monitoring and other medical quality initiatives and programs
• Physician must be able to supervise collaborating nurse practitioners and physicians assistants
• Physician must be able to utilize electronic/online medical tools such as EHR systems and state/county medical systems utilized for Death Certificates and administrative functions.

Requirements and Qualifications

• Board Certification Preferred: Family Medicine, Internal Medicine - Any Subspecialty, Geriatrics, etc.
• Candidate must hold a valid medical license in the state in which they will practice
• Candidate must hold a valid DEA license in the state in which they will practice
• Candidate must have completed a valid U.S. residency program
• Candidate must have completed a medical degree (MD or DO) from an accredited institution
• If applicable, state Controlled Substance License required.
• Reliable transportation is required.

Physical Requirements

• Must be able to move inside a facility frequently and briskly in order to see patients, meet with managers and facility staff, and attend to patient needs.
• Punctual in-person attendance (though schedule may be set, it is preferred that morning rounding occur, otherwise, whatever schedule is set, physician is expected to adhere to that schedule and to notify the clinical operations team when unable to adhere to the schedule for any reason).
• Continuous operation of app-based EMR/notes system either through a computer or on a mobile device (iPad, Phone etc.).
• Ability to ascend and descend stairs in a facility.
• Some ability to position oneself to obtain records, tools, medical equipment and other items that may be in locations that are below the knee or above the shoulder.
• Effectively communicate with patients, managers, and Facility staff in English.
• Ability to observe details in close range (within a few feet of the observer) in order to provide accurate and appropriate medical recommendations, treatment, and to provide timely updates to Managers regarding facility or patient concerns.
• Must be able to lift at least 25 pounds.

Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.

Requisition ID 5923625030

#TSMD2

Job Type: Part-time

Pay: Up to $400,000.00 per year

Benefits:

• Flexible schedule
• Professional development assistance

Schedule:

• Monday to Friday

Application Question(s):

• Do you have your DEA license? If not, are you willing to apply for one?
• Are you eligible to enroll and bill Medicare and Medicaid?
• Are you certified through your professional association? (i.e. ANCC, AANP, NCCPA, ABIM, etc)
• Would you like to be considered for future opportunities in your area or other states? If yes, please indicate if only for local opportunities or if for other states.
• If willing to travel, are you willing to obtain additional state licensing to travel and work in other states temporarily?
• Would you be willing to relocate to another state for a similar position? If yes, please list what states are of interest to you. (Transfer not mandatory).
• Has your professional license ever been suspended or is it currently under investigation?
• Do you have an active Iowa License?

Education:

• Doctorate (Preferred)

Willingness to travel:

• 50% (Preferred)

Work Location: On the road