Permanent Administrative Job in Linthicum Heights, Maryland
Chief Medical Director Opportunity in Maryland:
Job description
Position
Purpose: Direct and coordinate the medical management, quality
improvement and credentialing functions for the assigned business unit
based on, and in support of the strategic plan, establishing the
strategic vision and attendant policies and procedures.
Serves as clinical advisor to and educator of medical management
staff making sure correct clinical judgment is applied to all medical
management determinations.
Oversees internal medical review guidelines to ensure clinical
integrity and compliance and acts as a resource for staff members
throughout the operation.
Coordinates with other departments, the responses needed to address
regulatory accreditation concerns pertaining to medical management
issues
Performs medical review activities pertaining to utilization review,
quality assurance, and medical review of complex, controversial, or
experimental medical services.
Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
Responsible for physician review and oversight of all potential
adverse determinations including pre-certifications/prior
authorizations, concurrent review and appeals/retrospective review.
Responsible for HEDIS improvement and strategy.
Actively participates in the auditing process of medical management
processes and corrective action team projects for medical management
Achieves utilization, cost management and quality goals.
Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology
For Home State Health Plan only – responsible for the sufficiency and supervision of the health plan provider network
Education/Experience: Medical Doctor or Doctor of
Osteopathy, board certified in a specialty recognized by the American
Board of Medical Specialists. Volunteer patient care required. Previous
experience as Medical Director is preferred. Master’s degree in Business
Administration, Public Health, Healthcare Administration or related
field preferred.
For Immediate Consideration, Please Inquire Within