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Permanent Administrative Job in Indianapolis, Indiana

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  • Position Type: Permanent
  • Recruited Specialty: Administrative
  • Does the Physician Need To Be Trained In Specialty Being Recruited: No
  • Structure of Position: Admin/Medical Director
  • Partnership Opportunity: Unknown
  • Expected Patient Call Coverage: No call
  • Expected ER Call Coverage: No call
Practice Details

Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers.
  • Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
  • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies.
  • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
  • Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees
  • Consults on MCO clinical policy related to Substance Use Disorders and the cases of individual members for the MCM program on a routine basis.

  • Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine). The candidate must be an actively practicing physician. Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.

    • Financial Details
    • Structure of Financial Support: Income Guarantee, Straight Employment, Employment Agreement with production bonus, Contract
    • Financial Offering: Open
    • Relocation Allowance: Negotiable
    • Signing Bonus: Negotiable
    • Stipends: Negotiable
    • Student Loan Assistance: Negotiable
    Community Information
    • Practice State: Indiana
    • Practice City: Indianapolis
    • Community Size: 100,000 - 499,999, 500,000+
    • Community Details: Registered Candidates Only
    Candidate Qualifications
    • Location of Medical Training: American Medical Graduate (AMG), Foreign Medical Graduate (FMG)
    • Medical Training Type: Allopathic (MD), Osteopathic (DO)
    • Board Certification: Board Certified, Board Eligible
    • Work Status Requirements: US Citizen, Green Card
    • Preferred Experience Level: Recently Trained, Experienced, Very Experienced
    • Accept Local Physicians within 25 mile Radius: Yes
    Contact Information
    • Agency: SmartDocs Direct

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