NJM Insurance Group, a leading property-casualty insurer, has an immediate opening at our corporate headquarters in West Trenton, New Jersey for a Physician who will assist the Medical Director in directing and coordinating the medical management and quality improvement functions for managed care programs in Personal Injury Protection (PIP) and Workers’ Compensation lines of business.
The Physician will perform claim reviews and provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with NJM Medical Policies and evidence based guidelines. The individual will contribute to the educational activities of the organization.
Provide medical leadership of all utilization management, cost containment and medical quality improvement activities.
Perform medical review activities pertaining to utilization review, quality assurance, and medical review of utilization management programs in accordance with regulatory, state, corporate and accreditation requirements.
Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
Collaborate with the Medical Director in the development, implementation, evaluation and modification of Medical Policies.
Assist the Medical Director in planning and establishing goals related to corporate wellness strategies and wellness campaign initiatives.
Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
Develop alliances with the provider community, participation in provider network development, education and new market expansion as appropriate.
Assist in the development, implementation and presentation of all staff educational programs with respect to clinical issues and medical policies.
Communicate and work with staff to ensure coordinated efforts for the provision of high quality medical treatment and client service.
Assist in implementing special medical projects and services.
Maintain proper credentialing and state licenses and any special certifications necessary to perform the job.
Identify and utilize current resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision making and rationales in reviews.
Required Qualifications, Experience and Competencies:
Board-certified M.D., D.O. with an excellent understanding of appropriate utilization of services and the development of policies that support the services
Current unrestricted clinical license
Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required
Previous experience in the managed care setting is preferred
Postgraduate experience in direct patient care
Previous experience in Occupational, emergency, internal medicine or general practice, preferred
Demonstrated ability to perform review services
Strong decision making skills
Ability to work with various professionals including physicians, nurses, adjusters
Knowledge of current practice standards
Excellent written, oral communication and organizational skills
Detail oriented, able to work independently in an ever changing environment
Strong ability to multi task
Proficient in MS Office Word, Excel, PowerPoint and Outlook
NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.
About NJM Insurance
Insurance is our business. Service is our passion. That's what sets us apart in an industry whose most important job is to be there for people when they need us most. Our commitment to customer satisfaction is repeatedly recognized by leading, independent consumer publications, which rate us as providing among the best service in the country. Founded by customers for customers, at our core, we’re simply people devoted to helping people.