Description
We are hiring for a Medical Director. Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as a clinical/strategic advisor to enhance the clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program.
Primary duties may include but are not limited to:
Supports clinicians to ensure timely and consistent responses to members and providers
Provides guidance for clinical operational aspects of a program
Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations
Serves as a resource and consultant to other areas of the company
May be required to represent the company to external entities and/or serve on internal and/or external committees
May chair company committees.
Interprets medical policies and clinical guidelines
May develop and propose new medical policies based on changes in healthcare
Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality cost and outcomes
Identifies and develops opportunities for innovation to increase effectiveness and quality
Qualifications
Requires M.D. or D.O.
Board certification approved by the American Board of Medical Specialties required where applicable to duties being performed
Requires active unrestricted medical license to practice medicine or a health profession
10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
