I'm assisting a Fortune 500 Health Plan fill a Medical Director position
Ideal candidate will have Health Plan preferred, but also willing to train someone with the right attitude. Looking for someone who is high energy who can be successful with a high case load.
Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. Maintains a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff.
Facilitates conformance to regulatory requirements.
Reviews quality referred issues, focused reviews and recommends corrective actions.
Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency and continuity of care.
Develops and implements medical policies.
Conducts retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.
Job roles and responsibilities emphasize a team-based approach to care and support each member of the team being trained to meet the highest level of function allowed by state law.
Doctorate Degree in Medicine
Board Certified or eligible in a primary care specialty
• 7-9 years relevant experience, including:
• 5+ years clinical practice
• 2 years previous experience as a Medical Director
• 3 years experience in Utilization/Quality Program management
• 2+ years HMO/Managed Care experience
• Current clinical knowledge
• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen
• Knowledge of applicable state, federal and third party regulations
Required License, Certification, Association
Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
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