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 Steven at steven.heath@pcgstaffing.com or call 972.782.4515.