Remote National Senior Medical Director Focus will be developing UM strategy and policy for all plans in the company.Must have experience managing other managed care Medical Directors.
Must have experience as a Medical Director or CMO covering multiple states and their medical directors at the same time. Growing integrated healthcare provider seeks a National Medical Director to lead the company's utilization management clinical team across all states.
This is a 100% remote role. 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 Requirements :
M.D. graduate of an accredited medical school, MBA or advanced degree in healthcare management preferred
board certified in internal medicine, family medicine, emergency medicine or primary care.
4+ years experience as a physician reviewer performing peer review activities.
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