Interview with Dr. Rich Berning

Today's podcast is loaded with practical advice on how to pursue a job as a health plan medical director. My guest, Dr. Rich Berning, explains the various roles within that career. He also describes where you can find similar positions outside of health plans, such as with an Independent Review Organization or a hospital UM department.

Rich is a full-time medical director. He worked for Anthem in Albany, NY, for 5 years and recently accepted a promotion with another insurance company, in Pittsburgh, PA.

rich berning health plan medical director

Prior to entering the health plan world, Rich practiced pediatric cardiology for 20 years. He graduated from the University of Cincinnati College of Medicine. He completed his pediatrics residency at Stanford University and his cardiology fellowship at the University of California San Francisco.

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Rich Berning Takes a Leap of Faith

After 20 years in private practice, Dr. Rich Berning decided that it was time for a career change.

“I loved my patients. I loved the practice, but I was ready for a change. I got an opportunity to join Anthem Healthcare and Anthem Insurance. Not knowing anything about it, I pretty much took the leap.”

Experience not Required

Rich didn’t have dedicated time working in utilization management (UM) or a related field, but he did receive on-the-job-training.

“These health plans need doctors of every specialty, and they want you for your medical knowledge. They'll teach you what you need to know.”

After five years with Anthem, Rich transitioned to a state level plan in the Mideast. He is now a full-time medical director.

Physicians like to take care of patients. That's what we want to do. So, this is just a new way to do it, and it's an important part of the whole system.

Rich Berning

“In health insurance, everything is faster. You start out at a director level and you just pretty much come in with your medical experience and knowledge. It just seems to be a much quicker path.”

Experience and Knowledge Leads the Way

As a medical director, Rich tries to manage healthcare costs: How can we lower costs? How can we get better care to the patient? How can we keep them out of the hospital?

 

“That's when you really start using all your experience and knowledge, and that's the interesting part for me.”

Get Your Dream Medical Director Job

Gain experience any way you can, and then add it to your LinkedIn profile.

“Get seen and get noticed and get found, and I think LinkedIn is key to that. I really think that people who know people who are medical directors who have some ‘in’ are going to get hired before the people who are just trying out of the blue.”

The three most common duties in this field include fall into:

  • Utilization Review (UR): Pre- and post-service reviews for pre-determination. “That's kind of the bread-and-butter, everyday work that we all do.”
  • Utilization Management (UM): Reviews of clinical inpatient, surgeries, etc. “Hospitals will love you, if you go down to find out where the reviews…they get denials for continued stay, or even for the initial inpatient admission, and then fight them. I've done peer-to-peer calls kind of with hired guns, if you will.”
  • Case Management (CM): It's all about data. Health plans scan and sort their members/patients for diagnoses, re-admission frequency or high-cost claimants, etc. Then they provide direction for moving the patient through the system as quickly and efficiently as possible.

What Rich Likes Most

For Rich, being a medical director is a big, but rewarding responsibility.

“We get to solve problems, and that really makes me still feel like a doctor more than anything. I really enjoy that.”

You may get paid slightly less to start, but you don’t have to worry about being on call or malpractice.

“You get to take it to a much higher level. Now, you might be affecting hundreds of patients a day or more.”

In Summary

I hope you enjoyed our conversation as much as I did. Rich told us:

  • what a health plan medical director does,
  • what he likes about his role,
  • the expected salary range, and,
  • how to pursue this popular nonclinical career.

Coming Next Week

I’ve got one more interview with a speaker from the Physicians Helping Physicians conference coming up next week. I’m circling back to a medical science liaison, Dr. Swati Shah, because I’m getting ready to release a free mini-course on how to become an MSL.

I hope you join me then.

Links for today's episode:

Thanks to our sponsor…

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I hope to see you next time on the PNC Podcast.

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Disclaimers:

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life or business. 

Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counsellor, or other professional before making any major decisions about your career. 

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