Growing integrated healthcare provider seeks a Medical Director to lead the company's utilization management clinical team in the state of Virginia. This is a remote role, but candidates must be licensed and live in Virginia. The Medical Director will:
- Oversee daily utilization management activities including reviewing requests and making coverage determinations for services and supplies for delegated lines of business.
- Act in a supporting role as medical manager and policy advisor to the company and our clients.
- Executes the Utilization/Cost Management Programs and relevant Clinical Quality Improvement Programs in partnership with the Director, Care Management and Market Medical Directors
- Interfaces with provider community on Utilization Management and evidence based medicine
- Provides education to provider teammates in local markets and to the UM team regarding managed care processes as well as clinical issue
- M.D. graduate of an accredited medical school, MBA or advanced degree in healthcare management preferred
- Virginia licensure, board certified in internal medicine, family medicine, emergency medicine or primary care.
- 2+ years experience as a physician reviewer performing peer review activities.
- 3+ years experience in clinical practice in a primary care setting
- Progressive medical administration experience strongly preferred
- Proven ability in a medical leadership position in clinical credibility with experience developing and guiding team members
- A strong understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
- Strong interpersonal, verbal, and written communication skills.
- The ability to navigate in a corporate matrix environment