Medical Director(Paid Membership Site) - A Healthcare Company (Tampa, FL)
Reports to:
Sr.
Medical Director, FL LOB
Essential Functions:
Collaborates with the organization s senior leadership to ensure medical compliance with all customer, regulatory, and accreditation requirements for clinical services.
Manages day-to-day quality improvement and medical management activities.
Establishes and is accountable for health plan utilization, OS applications and quality outcomes.
Assures all internal and vendor medical review activities conform to company protocols, customer requirements, and professional standards.
Ensures adherence to assigned budget accountabilities.
Works closely with other medical directors and clinical services staff to attain and/or maintain compliance with company, customer, accreditation and regulatory requirements.
Collaborates with corporate care management to establish and implement clinical programs to support and meet care management goals Manages the application of all clinical aspects of the Credentialing Program, Credentialing Committee and Peer Review activities at the state level.
Shares responsibility for quality improvement and accreditation initiatives in the assigned market(s) Ensures compliance with federal, state and NCQA standards.
Establishes and maintains relationships with key stakeholders in partnership with the market leadership.
Performs other duties as assigned.
Qualifications Education:
Doctor of Medicine degree (M.
D.
) or Doctor of Osteopathic Medicine degree (D.
O.
) from an accredited school of medicine recognized by national medical regulatory bodies in the United States - required Licenses and Certifications:
Doctor of Medicine (MD) An unrestricted and current license to practice medicine in the state of employment (or the ability to obtain one) Board Certification
Experience:
5
years of experience in direct patient care - required Substantial experience and expertise in the development of medical policies, procedures and programs - required Demonstrated success implementing utilization and quality improvement strategies /techniques and experience with physician behavior modification - required Past participation in a managed care Utilization Management (UM) committee - preferred Skills:
Ability to communicate and make recommendations to upper management Ability to create, review and interpret treatment plans Demonstrated leadership skills Ability to work in a fast paced environment with changing priorities Demonstrated interpersonal/verbal communication skills Demonstrated organizational skills Ability to represent the company with external constituents Demonstrated negotiation skills Ability to influence internal and external constituents Ability to remain calm under pressure Must be able to apply medical knowledge and principles to business challenges in order to achieve significant member, business, and quality outcomes Must be detail-oriented and have a hands-on approach Clear understanding of the managed care field and managed care operating components, with emphasis on clinical management of health services, particularly within an integrated managed care model Clear understanding of regulatory systems and processes that affect managed care health system Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
Sr.
Medical Director, FL LOB
Essential Functions:
Collaborates with the organization s senior leadership to ensure medical compliance with all customer, regulatory, and accreditation requirements for clinical services.
Manages day-to-day quality improvement and medical management activities.
Establishes and is accountable for health plan utilization, OS applications and quality outcomes.
Assures all internal and vendor medical review activities conform to company protocols, customer requirements, and professional standards.
Ensures adherence to assigned budget accountabilities.
Works closely with other medical directors and clinical services staff to attain and/or maintain compliance with company, customer, accreditation and regulatory requirements.
Collaborates with corporate care management to establish and implement clinical programs to support and meet care management goals Manages the application of all clinical aspects of the Credentialing Program, Credentialing Committee and Peer Review activities at the state level.
Shares responsibility for quality improvement and accreditation initiatives in the assigned market(s) Ensures compliance with federal, state and NCQA standards.
Establishes and maintains relationships with key stakeholders in partnership with the market leadership.
Performs other duties as assigned.
Qualifications Education:
Doctor of Medicine degree (M.
D.
) or Doctor of Osteopathic Medicine degree (D.
O.
) from an accredited school of medicine recognized by national medical regulatory bodies in the United States - required Licenses and Certifications:
Doctor of Medicine (MD) An unrestricted and current license to practice medicine in the state of employment (or the ability to obtain one) Board Certification
Experience:
5
years of experience in direct patient care - required Substantial experience and expertise in the development of medical policies, procedures and programs - required Demonstrated success implementing utilization and quality improvement strategies /techniques and experience with physician behavior modification - required Past participation in a managed care Utilization Management (UM) committee - preferred Skills:
Ability to communicate and make recommendations to upper management Ability to create, review and interpret treatment plans Demonstrated leadership skills Ability to work in a fast paced environment with changing priorities Demonstrated interpersonal/verbal communication skills Demonstrated organizational skills Ability to represent the company with external constituents Demonstrated negotiation skills Ability to influence internal and external constituents Ability to remain calm under pressure Must be able to apply medical knowledge and principles to business challenges in order to achieve significant member, business, and quality outcomes Must be detail-oriented and have a hands-on approach Clear understanding of the managed care field and managed care operating components, with emphasis on clinical management of health services, particularly within an integrated managed care model Clear understanding of regulatory systems and processes that affect managed care health system Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
