Description

Medical Director

Overall Purpose:

The Medical Director is responsible for medical oversight of the Medical Management Program Description of organization regarding medical necessity decisions; utilization review, inclusive of prior authorization, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level. The Medical Director support achieving the Quadruple Aim: improved outcomes, improved patient experience, improved clinician experience and decreased cost of care.

Education and Experience:

• Current, unrestricted, medical license (MD or DO)
• Advanced degree such as MBA, MHA, MPH or MMM preferred
• Board certified and Primary Care preferred
• Appropriate unrestricted state medical licenses
• Minimum 5 years practice experience
• Minimum 2 years as a lead physician
• Knowledge of utilization management to include experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required.

Knowledge, Skills and Abilities:

• Strong problem-solving skills required
• Experience in a managed care organization preferred
• Knowledge of medical terminology required
• Excellent communication skills with patients, providers, internal and external customers required
• Must have excellent computer skills
• Must have excellent organizational skills, attention to detail, and ability to work independently

Essential Functions:

• Promote the mission, vision and values of organization
• Responsible for medical necessity decisions
• Plans and directs medical policies
• Responsible for strategic clinical relationships with physicians, identifying clinical trends, and directing data analysis
• Responsible for quality and continuous improvement
• Responsible for all actions/responsibilities as described in organizations controlled documentation for this position
• Contributes to and supports organizations quality initiatives
• Assist in developing in Utilization Management and Quality Management programs
• Develops policies and procedures, guidelines, and training to ensure compliance with federal, state, NCQA, health plan, and internal regulations
• Researches, identifies, and implements new technologies that contribute toward increased quality
• Leadership through designated monthly meetings

Organization provides competitive salary plus guaranteed bonus incentives. Full benefits including a $40K+ sign-on bonus also come with this great job opening. To apply please email copy of your cv to Travis at [Register to View] or call [Register to View] .