Senior Medical Director
Location: Columbia, South Carolina
Description: Atlantic Information Systems is currently interviewing Senior Medical Director right now, this position will be depute in South Carolina. Further informations about this position opportunity kindly see the descriptions. Job Description:
Medical Director or Senior Medical Director, South East
For confidential inquiries, please contact Molly Bilisoly, Healthcare Executi! ve Connections 757.652.1141 cellular/ office
757.440.1042 f ax
molly.p@verizon.net
www.healthexecconnect.com
POSITION PURPOSE: Perform duties to assist the plan CEO and direct and coordinate the medical management, quality improvement and credentialing functions for the health plan. Practices 6-8 hours a week.
POSITION QUALIFICATION REQUIREMENTS:
Knowledge/Experience: Requires a Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, OB/GYN, Pediatrics or Emergency Medicine). Licensed in state of SC or ability to obtain SC license. 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.
Skills/ Competencies: A! bility to work collegially with other clinical and non-clinica! l personnel within the health plan. Broad medical knowledge and ability to understand and apply medical principles across multiple specialties. Deal with several abstract and concrete variables. Perform data analysis and communicate results to physicians and other plan providers. Ability to constructively influence physician behavior to promote quality and efficiency in health care. Perform reading, writing and speaking at an advanced level. Read periodicals, journals, manuals. Prepare business letters, expositions, summaries and reports using prescribed format and conforming to all rules of punctuation, grammar, diction and style. Ability to use computer systems for the management, reporting and presentation of information, as well as correspondence. Ability to travel.
CRITICAL JOB ELEMENTS: Excellent verbal, written and non-verbal communications skills.
PRINCIPAL FUNCTIONS & ACCOUNTABILITIES:
Leadership/Supervision: Provides medi! cal leadership of all of assigned health plan’s 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. Oversees provider credentialing.
Strategic Orientation: Assists CEO in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for health plan members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
Significant Duties: Assists the CEO in the functioning of the Plan’s physician committees including committee structure, processes, and membership. Oversees the activ! ities of physician advisors. Utilizes the services of medical and pharm! acy 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 plan policies.
Quality Improvement Orientation: 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 the plan in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care rendered plan members. With the support of Medical Services and Provider Relations interfaces with physicians and other providers in order to facilitate implementation of recommendations to HMO providers that would improve utilization and health care quality. In conjunction with the Corporate Claims Departme! nt and Medical Review Unit, reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
Budgeting: Assists the CEO in monitoring and analyzing costs in preparation of the departmental budget.
Internal and External Communications: Develops alliances with the provider community through the development and implementation of the medical management programs, interfacing directly with the provider community regarding medical review, utilization review, and quality improvement issues and concerns. As needed, may represent the plan before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the plan at appropriate state committees and other ad hoc committees.
For a confidential discussion, contact
Molly Bilisoly
Healthcare Executive Connections
757.652.1141
molly.p@verizon.net
- .
If you were e! ligible to this position, please email us your resume, with salary requ! irements and a resume to Atlantic Information Systems.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position will be started on: Tue, 19 Mar 2013 17:45:20 GMT
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