Medical Director

5 - 7 years experience  • 

Salary depends on experience
Posted on 03/20/18
San Francisco, CA
5 - 7 years experience
Salary depends on experience
Posted on 03/20/18

WHO WE ARE

As a member of the Berkshire Hathaway group of insurance companies, we offer outstanding opportunities for professionals interested in working with a successful company. We offer unparalleled financial strength, stability and “large company” benefits, in addition to an exciting, friendly, “small company” atmosphere.

POSITION DESCRIPTION

Berkshire Hathaway Homestate Companies has an opening in our San Francisco, CA Officelocation for a MedicalDirector.  The MedicalDirector is responsible for providing thought leadership, direction and functional expertise for the betterment of our medicalnetwork, vendor panels, and overall medical management strategy with the goal of providing injuredworkers with effective and efficient medical care for the treatment of their compensable injuries.  This position coordinates and maintains collaborative relationships with keyinternalpartners across the organization determining trends and opportunities to create tools, programs and consistent medical “best practices” that deliver better outcomes, bringing value to our policyholders while minimizing medical costs.  Responsibilities also include working with key external stakeholders, providers, vendors, and industry associations to foster effective relationships for optimal Claims outcomes and to enhance our brand in the market.

RESPONSIBILITIES

  • Provide expertise and maintain the Company’s Medical Provider Network (MPN) and vendor panels for the treatment of injured workers. 
  • Provide oversight and analytics of providers and vendors within the Company’s MPN and panels, and work with the Company’s data analysts in creating and enhancing outcome measurements. 
  • Continually analyze Company and industry data to increase the Company’s capacity to understand the effectiveness and efficiency of providers, vendors, and treatment methods, and provide guidance for improved management and treatment oversight.  Apply data analytics, predictive models and industry trends to work with the Director of Medical Management in enhancing utilization management strategies. 
  • Develop and implement initiatives focused on functional restoration and/or return to work in conjunction with Claims for high exposure injury types, such as Complex Regional Pain Syndrome. 
  • Collaborate with Claims and Medical Management staff to provide medical expertise during the investigation and strategic evaluation of individual claims, to include medical record review and participation in roundtable discussions with key Claims and Medical Management staff to provide guidance as to appropriateness and cost-effectiveness of medical treatment and services and assist in projecting medical costs for reserving and settlement strategy. 
  • Act as a liaison and advisor for internal partners communicating with healthcare providers and directly engaging with providers as appropriate.
  • Ensure our associated providers and vendors within the Company’s MPN and panels operate in compliance with Company policies, certification standards, and state and federal statutes and regulations. 
  • Provide insight and guidance regarding common injury types and trends, return to work strategy, and other key Claims medical management topics to expand and enhance the Company’s Claims-related learning and development initiatives. 
  • Collaborate with Marketing, Client Services and Underwriting departments to enhance client relationships and become a key face of the Company in attendance at Company client events and panels, enhancing our brand in the market. 
  • Provide feedback for initiative development within industry professional organizations and associations, coordinate and maintain collaborative relationships within key medical professional and trade organizations, regulatory committees or commissions to ensure Company presence and enhance our brand in the market.

QUALIFICATIONS

  • Education – Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) from an accredited US medical school; Advanced degree beyond MD or DO (i.e., MPH) is preferred but not required; Current active license to practice in the United States. 
  • Experience – Board certified, preferably in one of the following specialties:  Occupational Medicine, Orthopedic Surgery, Physical Medicine and Rehabilitation (PM&R), or Internal Medicine with a minimum of five years clinical experience in same; Certified Medical Review Officer (MRO) preferred; Member/Fellow of American College of Occupational and Environmental Medicine (ACOEM) or history of active participation in regional and/or national specialty society activities and/or committees, ideally at a leadership level ; Proven credibility in the medical community.  Two or more years experience in medical research; Experience in the following highly desirable, though not required: Managed care, Utilization review, Disability insurance, Academic teaching or preceptorship, Oversight of multidisciplinary teams.
  • Language – Ability to read and interpret documents such as procedure manuals and operating instructions; Ability to write routine reports and correspondence; Ability to speak effectively before groups of customers or employees of organization; Ability to create an open environment conducive to freely sharing information and ideas. 
  • Reasoning – Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form; Ability to deal with problems involving several concrete variables in standardized situations. 
  • Math – Ability to add, subtract multiply and divide in all units of measure, using whole numbers, common fractions and decimals; Ability to compute rate, ratio and percent and to draw and interpret graphs; Ability to do statistical analysis to help identify drivers of key outcomes and to develop some predictive modeling; Ability to analyze data, perform variance analysis and identify issues and trends.
  • Computer – Knowledge of Microsoft word processing software, Microsoft spreadsheet software, and be proficient on applicable databases, systems and vendor software programs. 
  • Technical – Knowledge of medical networks and panels, medical claims outcome analysis and current medical technologies.  

COMPREHENSIVE BENEFITS PACKAGE:

  • Health and wellness – low premiums for medical, dental and vision coverage, FSA and EAP benefits
  • Company paid Life, Disability and ADD benefits
  • Employee Retirement Savings Plan with employer match up to 5 percent of compensation
  • Generous Paid Time Off and Holidays
  • Education Assistance Reimbursement
  • Recognition and Rewards Programs
  • Company Store
  • Discounts across Berkshire Hathaway Inc. companies such as GEICO, See’s Candies, etc.
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