Job Post: Associate National Medical Director

Job Post: Associate National Medical Director
Amerigroup Corporation - Norfolk, Virginia Area

Job Description

Provide clinical leadership and expertise to the development and implementation of national programs designed to assure members receive appropriate and timely access to health care services in a cost effective manner. Under the direction of the National Medical Director, provide clinical support to the Reimbursement Policy Management Department, Clinical Operations Department, Pharmacy Department and other Amerigroup departments as assigned. Work collaboratively with HCMS and other Amerigroup departments to achieve overall organizational goals and objectives.

Job Post: Managed Care Medical Director (includes salary info)

Medical Director
Aetna - Phoenix, AZ

POSITION SUMMARY
The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical and business leader and contact for external providers, plan sponsors, and regulatory agencies and participates in the strategic medical management of local markets.

American Medical Forensic Specialists

Here's some information about an organization called the AMFS:

American Medical Forensic Specialists (AMFS) is America's premier medical expert witness and medical legal consulting company. We have been a trusted partner with the legal community for more than 20 years providing experts to both plaintiff and defense counsel for personal injury, medical malpractice and other medical-legal matters. Our superior method of retaining the most qualified experts has enabled us to provide board-certified experts in active practice in over 15,000 malpractice and personal injury cases.

Benefits of joining the AMFS network:

* Earn supplemental income without disrupting your practice
* Keep informed of issues affecting your specialty and the medical community
* Accept or decline casework at your discretion and according to your schedule
* Outsource all non-billable administrative tasks and ensure payment for services rendered
* 20 years and 15,000 cases of medical-legal experience and expertise
* Receive complex case facts and briefings from a doctor (AMFS Medical Director)

Learn how you can become an AMFS expert here. (panel of experts limited to actively practicing, board-certified physicians who are willing to testify in support of their unbiased opinion)

Physician Careers: Commercial Payors - Dr. John Fallon (MD/MBA 8th AMMP Conference)

Here's a video of a presentation given by Dr. John Fallon at the 8th Annual AMMP conference titled, "Government Payer Careers." I blogged about his presentation (here) back in April when I was in Boston attending the Association of MD/MBA Programs (AMMP) 8th Annual Conference.

Now, you can view a video of his presentation and slides here (you'll need Microsoft Silverlight to play the video).

John Fallon, MD, MBA
Senior Vice President
Chief Physician Executive
Blue Cross Blue Shield of Massachusetts

John is responsible for ensuring the highest standards of medical care for our members. He is also accountable for helping expand health care strategies involving quality, effectiveness, efficiency and their relationships to new payment methodologies. He oversees the company’s medical policies, acts as the main liaison with the plan’s provider network, reviews upcoming legislation for medical impact, manages the company’s medical directors, acts as primary spokesperson for medical inquires and main medical contact with the Blue Cross Blue Shield Association and its 39 plans.

Physician Careers: Government Payors - Dr. Richard Kalish (MD/MBA 8th AMMP Conference)

Here's a video of a presentation given by Dr. Richard Kalish at the 8th Annual AMMP conference titled, "Government Payer Careers." I blogged about his presentation (here) back in April when I was in Boston attending the Association of MD/MBA Programs (AMMP) 8th Annual Conference.

Now, you can view a video of his presentation and slides here (you'll need Microsoft Silverlight to play the video).

Richard Kalish, MD, MPH
Medical Director
Boston HealthNet
Boston Medical Center HealthNet Plan

Richard Kalish, MD, MPH, MS, is an assistant professor of medicine and family medicine at Boston University School of Medicine and Director for Community Engagement at Boston University Clinical and Translational Science Institute (BU CTSI). He is Medical Director of Boston HealthNet, a network of fifteen community health centers, Boston Medical Center and the Boston University School of Medicine. He is the chairman of the Boston HealthNet Research Sub-Committee. In addition, he is Medical Director of the Boston Medical Center HealthNet Plan, a provider-sponsored Managed Care Plan with insurance products in both Medicaid and Commonwealth Care (a government sponsored product which came about with Massachusetts Health Care reform in 2006). In both of these medical director roles Dr. Kalish works with community health centers, hospitals serving the underserved and other safety net providers. The work involves population and disease management models aimed at improving the health of people and communities. The models focus on both chronic diseases and prevention. In addition, he has led practice redesign efforts in the network. Results have included processes to improve access in ambulatory practices, utilization of an electronic medical record for decision support and improved communication between health care providers. Currently he is involved in working on establishing medical home care environments in a few of the community health centers.

Health reform driving layoffs in the insurance industry

It's no surprise that insurance companies are restructuring in anticipation of major health reform changes. There's one article published in American Medical News titled, "Another insurer blames health reform for layoffs."

Assurant Health says the cuts will help "streamline its organizational structure" to prepare for changes in the insurance marketplace.

This is probably not the best time to leave clinical medicine to pursue non-clinical career opportunities in the health insurance industry. Then again, maybe the government will need to hire hundreds of physicians to serve as medical directors for the Public Option. Would you like to work for the government so that you can deny medical claims? How will the government define "medical necessity" as they roll out the Public Option to the 46 million uninsured individuals who are living in the United States?

American Academy of Insurance Medicine (AAIM)

The American Academy of Insurance Medicine (AAIM) is among the oldest medical specialty organizations in the United States. Our physician members typically serve as medical directors to insurance companies. Members may serve these companies as advisors for underwriting and consultants for claims and disability management. Other roles include medical and actuarial research, underwriting guideline development, employee health education and care, and as professional liaison to the medical community, legislative bodies and regulatory agencies.

Membership is open to physicians who are Medical Directors of insurance companies, nurses, underwriters, medical consultants and other professionals working in insurance medicine, as well as to affiliates who have a professional interest in insurance medicine.

http://www.aaimedicine.org

Medical Director jobs at UnitedHealthCare

This week, I've noticed a few new managed care job opportunities on the American College of Physician Executives (ACPE) group on LinkedIn.

One job is titled: "UnitedHealthcare Market Medical Director"

Qualifications:
" Licensed physician REQUIRED
" Board Certified in ABMS specialty; active, unrestricted license REQUIRED
" 5+ years clinical practice experience REQUIRED
" Supervisory skills, including clinical mentoring and coaching expertise
" Excellent presentation skills for both clinical and non-clinical audiences
" Excellent interpersonal communication skills (telephonic and face to face)
" Knowledge of managed care industry
" Data analysis and interpretation experience and skills
" Strong belief in EBM philosophy

To view these types of job opportunities on LinkedIn, you'll need to join LinkedIn (which is free, but they also offer paid premium services) and then join the ACPE group on LinkedIn. Non-clinical physician jobs in the health insurance company industry often require you to have an active medical license and board certification. 

Actuarial science

The other day, someone asked me if I was familiar with career opportunities for people who wish to pursue actuarial science. Are you familiar with actuaries?

Here are some interesting snippets from the US Bureau of Labor and Statistics website on Actuaries:

Most actuaries are employed in the insurance industry, specializing in either property and casualty insurance or life and health insurance. They use sophisticated modeling techniques to forecast the likelihood of certain events occurring, and the impact these events will have on claims and potential losses for the company.


Within the life and health insurance fields, actuaries help companies develop health and long-term-care insurance policies by predicting the likelihood of occurrence of heart disease, diabetes, stroke, cancer, and other chronic ailments among a particular group of people who have something in common, such as living in a certain area or having a family history of illness. Such work of actuaries can be beneficial to both the consumer and the company because the ability to accurately predict the likelihood of a particular health event among a certain group ensures that premiums are assessed fairly based on the risk to the company. Additionally, life insurance actuaries help companies develop annuity and life insurance policies for individuals by estimating how long someone is expected to live.

Things you need to know about disability insurance

This is a guest post by Donald Brown D.O.

Things you need to know about disability insurance

Your need for disability insurance is greater than your need for life insurance. Most people have no problem purchasing life insurance yet they hesitate to purchase disability insurance. Physicians like anyone else are not invincible. 43% of all people age 40 will experience a long-term disability event before age 65 (JHA Disability Fact Book, 2006)

Without a disability plan in place, will you be able to maintain your standard of living if you are not working? Can your family survive on one income when most families struggle with two people employed? How long before your savings are decimated?

Student loans are a concern for physicians who are just starting out. These loans are not discharged in the event of bankruptcy. Paying them off or expiring are two ways to eliminate them. You are responsible for them even if you are disabled. SallieMae.com states on their web site that loans may be "discharged" if you are disabled. They continue to state that even if you qualify for social security disability (extremely difficult to qualify for) you may not qualify for "discharge", and it will take a minimum of three years due to Federal Regulations, during which time you are still responsible for the debt.

MD/MBA Careers: Government Payors

Here at the Association of MD/MBA Programs (AMMP) 8th Annual Conference, Richard Kalish, MD, MPH (Medical Director of Boston HealthNet) spoke about his non-traditional career path to becoming a physician. He worked in the consulting industry before attending medical school. After completing a residency in internal medicine, he pursued a general medicine fellowship that included health services research and an MPH.

Here's his quote: "Find work you love, and you will never work a single day in your life."  Confucius

From 1996 to 2001, he was a medical director for the South Boston Community Health Center. He enjoyed working with data and wanted to find ways to reduce health care waste. From 1998 to the present, he been serving as the medical director for Boston HealthNet which includes 15 community health centers, the Boston Medical Center, and the BU School of Medicine. He's been dealing with decisions about electronic health records, interactions with community physicians, and . From 2001 to the present, he has been serving as the medical director for Boston Medical Center HealthNet Plan. Now, he deals with Medicaid, Commonwealth Care, and he leverages managed care organizations with community health to develop pay-for-performance plans and quality initiatives. He continues to stay involved with the BU School of Medicine in research and medicine. The entire time through his career. Dr. Kalish has maintained a primary care practice.

How will health care reform impact your job satisfaction?

If you're a health care professional involved in direct patient care, how will the proposed health care reform impact your level of job satisfaction? My wife is a primary care physician and we often talk about how a reformed health care system would impact her practice. Would you be more inclined to leave clinical medicine to pursue a non-clinical career?

I have met so many disgruntled physicians who feel "trapped" by their career. They can't imaging doing anything else. They don't know how they can make a career transition and they can't afford to take huge risks.

How closely are you following the discussion on health care reform? Even if you hate politics, it's very important to understand what's being proposed. It's not just about Medicare or the Public Option. It's not just about managed care companies and denied coverage. Perhaps all the recent discussions have renewed your writing passions as you draft letters to your senators. Perhaps you've recognized that you have a passion for health policy and politics. Maybe you're seeing the forest instead of the trees and you're planning to pursue a career in public health.

I've noticed that I can't see the trees anymore. For me, it's mostly about the forest. Blame that on my MPH. When we compare population health against individual health, we can't deny that our nation needs a new health care system. I just don't know that we've identified the right way to approach this problem yet.

Grand Rounds Volume 6 No 6

Welcome to Grand Rounds Volume 6 No 6. I'm Dr. Joe Kim and I'm your host this week. I’ve hosted Grand Rounds on my one of my other blogs (http://www.MedicineandTechnology.com) but today, I’m hosting Grand Rounds from my other blog http://www.NonClinicalJobs.com. Thanks for joining me here this week as we look through the "non-clinical" lens this week.

The theme this week is on non-clinical areas within health care. Since we’re all bloggers, we all embrace some elements of writing and journalism. These areas of medical communications continue to grow each year. Let's explore several different non-clinical sectors within the world of health care:

Public Health and Patient Safety

Let's consider the non-clinical world of public health and population health. Look beyond the individual patient for a moment. Let's look at the larger population. Marya from Healthcare, etc. evaluates our health care system and asks, “Will more healthcare bring better health?” It's not a simple answer when you examine the public health effects of socioeconomic status, environmental factors, behavior, and others. There are many non-clinical careers in the world of public health where you can explore how these factors impact health care.

Stacey at the ACP Internist reminds everyone to Get your darn flu shot! What more needs to be said? I've gotten my flu shot. Have you? Don't be a public health hazard by avoiding immunization (although herd immunity may protect us to a point).

Speaking of the flu, Duncan Cross had the flu last week and he writes about Dr. Cross’s* Compendium of Useful Illnesses. (*Duncan Cross is not a doctor.)

Speaking of vaccines, Dr. Charles from The Examining Room of Dr. Charles writes about his experience with the H1N1 Shot. Are you ready for your shot?

Rita from Supporting Safer Healthcare writes about the importance of patient safety and potentially dangerous doctors. Consider this: Hiding a Problem Doctor in Plain Site.

Nancy from Teen Health 411 writes about Set Your Clocks and Check Your Stocks! The Get Ready Campaign from the American Public Health Association has a great website to help your family be prepared for emergencies.

DrRich from The Covert Rationing Blog writes about the topic of Preventive Medicine - Those Clueless Cardiologists Are At It Again. Preventive medicine and public health are very closely linked and you'll have to read his post to follow how our politicians (and our clueless cardiologists) have energetically tried to medicalize preventive healthcare, thus rendering it an extremely expensive and often-barely-useful endeavor. Real preventive healthcare takes place in the home.

Medical Management

Barbara from Florence dot com writes about the root causes of different types of errors in Why a trick is still a treat. Are health care leaders implementing the right types of risk reduction strategies? The non-clinical world of medical management may be right for you if you like to develop and implement health policies.

Health Care and Politics

Jonathon from Receiving writes about Politics, Parasites, and a Proof of Principle. I generally try to avoid politics, but you can read about one doctor's opinion on how to solve the health care crisis. Many physicians have left clinical practice to pursue a non-clinical career in politics. I certainly won't be one of them.

Wellness and Fitness

Dr. Jolie Bookspan from The Fitness Fixer has been collecting some interesting data about sitting straight up. Read about it here: Fast Fitness - Contest: What Does It Take To Sit Upright? Back health is important, but do you know how to keep your back healthy? The health and fitness industry is another area where health care professionals are finding some interesting non-clinical opportunities.

Health Insurance and Managed Care

How to Cope with Pain writes about Help with Insurance Co-Pays. Learn about an organization that subsidizes co-pays for patients with certain diseases for whom there is financial hardship. This organization's overall goals are both to help patients get needed medical care as well as maintain financial stability.

Henry from InsureBlog writes about Unintended Consequences: Wellness, Genetics and GINA. Sometimes what seems like a good idea has hidden pitfalls. InsureBlog reports on a new genetics testing law that could end up hurting the folks it purports to help.

David from the Health Business Blog writes about how the Fears of the public option are overblown. The Business Roundtable is vehemently opposed to the public option. In this post I argue their position doesn't make sense.

Speaking of health insurance and managed care, many physicians, pharmacists, and nurses have left clinical practice to work for insurance companies. I wonder how these companies will change if we see a public option emerge.

Pharma

Amy from Diabetes Mine writes about Talking to Pharma, Online and Offline. The world of social media is evolving rapidly. Do patients and health care professionals know how to leverage social media properly?

Speaking of pharma, Louise from the Colorado Health Insurance Insider writes about How the Pharmaceutical Industry Drives Health Care Costs. Why are some drugs so expensive in this country compared to other countries?

Wilderness Medicine

Need to escape the hospital? Then perhaps you'd like to consider wilderness medicine. Paul from Medicine for the Outdoors writes about Sea Urchins and Such.

If you're in the wilderness, you may meet some interesting parasites. DrVes from Allergy Notes writes about Helminth Trichuris suis (pig whipworm) had no effect as therapy for allergic rhinitis. Fascinating.

Technology

DrVes from Clinical Cases and Images writes about how Hospitals mandating use of smartphones for affiliated doctors. I couldn't live without my smartphone and I know many others who feel the same way. Which smartphone operating system will dominate health care as more physicians switch from PDAs to smartphones? Speaking of smartphones, I hope you'll join me at my other blog (

Research

When we speak of research, we may think of clinical research, basic science research, and then we may get into non-tradition research, dietary research, etc. Well, speaking of food, Laika from Laika's MedLibLog writes about this: Hot News: Curry, Curcumin, Cancer & Cure. Now I love curry, but I don't think that we should all start eating curry to kill cancer cells.

This concludes Grand Rounds Volume 6 No 6. here at NonClinicalJobs.com. I hope you enjoyed looking at some different areas within health care through a non-clinical perspective.

Disabled physicians can still work non-clinical jobs

Recently, I've been speaking to several disabled physicians. I've been reminding them that they may be able to work a non-clinical job and still collect disability. This ultimately depends on the type of disability insurance you have. Some disabled physicians stop looking for any type of work because they think they may not be able to collect their disability if they start working in any capacity. You have to check your policy to determine what type of insurance you carry.

If you're disabled but you'd still like to contribute to the medical community, there are many things you could potentially do. Computing technology continues to improve and modern computers are now very easy to use for many disabled individuals. Voice recognition software has gotten very sophisticated (did you know that Microsoft Vista has voice recognition built into the operating system?). There are many different types of keyboards and mice. Some prefer pen-based input and they are using Tablet PCs to do their work. Others are simply dictating and having their words transcribed.

Non-clinical job opportunities for disabled physicians obviously depend on your type of disability. Consider a few of these options:

• Medical writing and communications (maybe even some form of journalism)
  
• Professional and consumer health education
  
• Medical consulting on the phone and on the Internet
• Teaching and tutoring (there are many medical students who could use some help)
• Project management
• Clinical research
• Case reviews for insurance companies
• Venture capital and market research
• Health information technology
• Recruiting other healthcare professionals (most of this is done by phone and e-mail)
  

There are obviously many other non-clinical jobs, but I just wanted to get some wheels moving. Perhaps you want the flexibility to work from home. As long as you have a phone, an Internet connection, and a computer, you can probably do most of your work right there. To read a bit more about some of the options listed above, I encourage you to start with: Non-Clinical Medical Opportunities for Physicians and Other Clinicians

Part-Time Malpractice Insurance?

If you're a physician, but you only see a few patients each week, should you get a lower rate on your malpractice insurance? What's all this talk about part-time malpractice insurance?

This question was answered by Medical Economics in a Q&A format, and the bottom line seems to be that malpractice insurance is determined by the number of hours you work and not by the volume of patients you see.

So, if you're thinking about reducing your clinical volume so that you can start exploring some non-clinical opportunities, think about the amount of time you'll be spending in your clinical practice. Maybe you'll qualify for part-time malpractice insurance if your hours in the medical office are less than 40 hours/week (I'm not an insurance agent, so maybe I shouldn't be making these types of statements).