Chief Medical Director - Baltimore, MD
If you are seeking a truly purposeful career with an opportunity to improve quality of care for vulnerable populations, and do MUCH more than UR, you may wish to consider joining this health plan.
GENEROUS relocation- excellent career growth!
Executive Leader will direct and coordinate the medical management, quality improvement and credentialing functions for the Maryland market. Collaborate with health plan leadership on establishing the strategic vision for the plan.
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
- Medical Doctor or Doctor of Osteopathy
- Board certified
- Continuing part time patient care required.
-Previous experience as Medical Director is preferred.
-Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
- Current medical license without restrictions
- Managed Care Experience - Utilization Review Experience
-Quality/Risk and HEDIS knowledge
-MBA/Six Sigma Leadership are an added plus