• 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.

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.

After 90 days, the successful candidate will have the option to work up to 3 days per week remotely.

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  Assist the Medical Director in planning and establishing goals related to corporate wellness strategies and wellness campaign initiatives. Assist in the development, implementation and presentation of all staff educational programs with respect to clinical issues and medical policies. Assist in implementing special medical projects and services.
• Provide medical leadership of all utilization management, cost containment and medical quality improvement activities. Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
• Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. 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.
• 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. Communicate and work with staff to ensure coordinated efforts for the provision of high quality medical treatment and client service. Maintain proper credentialing and state licenses and any special certifications necessary to perform the job.
• Collaborate with the Medical Director in the development, implementation, evaluation and modification of Medical Policies.
• Develop alliances with the provider community, participation in provider network development, education and new market expansion as appropriate.

• 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.

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  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. Proficient in MS Office Word, Excel, PowerPoint and Outlook.
• Board-certified M.D., D.O. with an excellent understanding of appropriate utilization of services and the development of policies that support the services. Knowledge of current practice standards.
• Current unrestricted clinical license.
• Demonstrated ability to perform review services.
• Strong decision making skills. Excellent written, oral communication and organizational skills.
• Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required.

• 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