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Medical Director--Chicago
Buford, Georgia, United States
Job Summary
Occupation
Physician
Specialty
Internal Medicine
Degree Required
MD/DO
Position Type
Permanent/Full-Time
Work Environment
Ambulatory Surgery Center (ASC)
Academic/Training Program
Hospital
Clinic/Private Practice
Location
Illinois, United States
Visa Sponsorship
No
Job Description
Last Update:
8/11/14
When you join this INCREDIBLE leadership team you will collaborate with the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
You will:
** Provide medical leadership for UM, cost containment, and medical QI activities.
** Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
** Support effective implementation of performance improvement initiatives for capitated providers.
** Make an important contribution in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
** Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
** Assist the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
** Oversee the activities of physician advisors.
** Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
** Participate in provider network development and new market expansion as appropriate.
** Assist in the development and implementation of physician education with respect to clinical issues and policies.
** Identify utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
** Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
** Interface with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
** Develop alliances with the provider community through the development and implementation of the medical management programs.
** As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
** Represent the business unit at appropriate state committees and other ad hoc committees
Qualifications:
Ideal candidate will be a Medical Doctor or Doctor of Osteopathy
Board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
Board Certification through American Board Medical Specialties required.
Previous experience within a managed care organization preferred.
Experience treating or managing care for a culturally diverse population preferred.
Are you interested in a conversation?
You will:
** Provide medical leadership for UM, cost containment, and medical QI activities.
** Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
** Support effective implementation of performance improvement initiatives for capitated providers.
** Make an important contribution in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
** Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
** Assist the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
** Oversee the activities of physician advisors.
** Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
** Participate in provider network development and new market expansion as appropriate.
** Assist in the development and implementation of physician education with respect to clinical issues and policies.
** Identify utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
** Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
** Interface with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
** Develop alliances with the provider community through the development and implementation of the medical management programs.
** As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
** Represent the business unit at appropriate state committees and other ad hoc committees
Qualifications:
Ideal candidate will be a Medical Doctor or Doctor of Osteopathy
Board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
Board Certification through American Board Medical Specialties required.
Previous experience within a managed care organization preferred.
Experience treating or managing care for a culturally diverse population preferred.
Are you interested in a conversation?