The Position Medical Director - South Carolina
Benefits - Full
Relocation Assistance Available - Possible for the ideal candidate
Commission Compensation - No
Bonus Eligible - No
Overtime Eligible - No
Interview Travel Reimbursed - No
Candidate Experience 7+ to 10 years of experience
Management Experience Required - No
Minimum Education - Doctoral
Willingness to Travel - Occasionally Candidate Screening Questions Does candidate have a current medical license without restrictions in South Carolina or the ability to obtain one
Description The Medical Director works closely with matrix partners to manage utilization management and case management activities within assigned market. The incumbent assists in the recruitment of participating providers, supports provider relations activities, monitors and actively manages performance of participating physicians, and assists in the development and implementation of medical policy. In addition, the Medical Director works in conjunction with the Divisional Medical Director to attain quality management goals that meet or exceed quality standards as established by all external agencies, participates in the identification and analysis of medical information from multiple sources in order to develop interventions to improve the quality of care and outcomes, and provides innovative solutions for key business drivers and leads efforts to improve upon these metrics
Education: A medical degree from an accredited medical school and board certification.
- Leads medical management and quality initiatives for assigned area to include utilization management through a matrix partnership, Quality Improvement & accreditation initiatives, Pharmacy utilization, quality and cost management of provider network, and program leadership for various corporate and local initiatives designed to improve member care and minimize unnecessary costs.
- Interprets medical policy for associates to facilitate the healthcare needs of plan members.
- Works closely with P&L owners to develop strategies to change member and provider behavior to improve quality of care, while also reducing medical costs.
- Works closely with and influences key business partners within a matrix organization faced with competing priorities.
- Makes recommendations (based on daily activities of evaluating members' care) about medical policy, clinical criteria and administrative process.
- Chairs medical policy, credentialing, and related health plan committees.
- Works with the medical community to assist in the development and maintenance of a strong, quality network of providers.
- Supports provider relations and risk contracting through education, provider visits and problem resolution.
- Visits targeted providers for recruitment, as well as performing proactive provider visits as scheduled.
- Works with quality management and medical cost analysis staff to identify trends in treatment and outcomes by interpreting various data.
- Reviews provider and member complaints, assist in resolution, and make recommendations for changes.
- Utilizes clinical expertise to assist in the development of care improvement programs to improve health outcomes for the member population.
- Manages and develops direct reports who include directors and/or managers.
Licensure: Current medical license without restrictions in South Carolina or the ability to obtain SC license.
Please send CV to firstname.lastname@example.org
- A minimum of seven (7) years experience and a strong working knowledge of managed healthcare.
- Experience in Family Practice, Pediatrics, or Obstetrics and Gynecology is highly preferred.
- Experience and familiarity with government programs is preferred.
- Past experience with NCQA accreditation is preferred.
- Demonstrated success implementing utilization tools/techniques and experience with physician behavior modification is required.
- Participation in hospital managed care or medical practice UM committees, desirable.
- Education, training, or professional experience in medical or clinical practice.