Chief Medical Director (Managed Care)

Location: Chesterfield, MO
Chief Medical Director (Managed Care)
 
Joining this team means you'll be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. The group is a fast, agile, customer-focused organization with a commitment to implementing the latest technologies.
 
Our client serves more than 55 million managed care members through their portfolio of high-quality commercial and government sponsored healthcare programs. The broad offering of programs that they provide has helped them to build both capacity and capability to successfully navigate a changing healthcare environment, while continuing to offer better health outcomes at lower costs.
 
Position Purpose:
Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures.
 
Job Description:
  • Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
  • Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.
  • Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues
  • Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
  • Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
  • Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.
  • Responsible for HEDIS improvement and strategy.
  • Actively participates in the auditing process of medical management processes and corrective action team projects for medical management
  • Achieves utilization, cost management and quality goals.
  • Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology
 
Qualifications:
Education/Experience:
  • Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists.
  • Volunteer patient care required.
  • Previous experience as Medical Director is preferred.
  • Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
 
Preferred Skills/Experience:
  • Experience working for a Managed Care Organization
  • Medicaid
  • Medicare
  • Change Agent. Track record of Innovation
  • Specific knowledge on HEDIS and Quality
  • Ability to manage higher acuity population.
 
Licenses/Certifications:
  • Board Certification through American Board of Medical Specialists.
  • Current state medical license without restrictions.
 
Our client offers options that allow you to do more than just plan for retirement. Their programs allow shared success with employees.
  • 401(k) with company match
  • Employee stock purchase plan
  • Training and Learning Opportunities/Tuition Reimbursement/Educational Assistance
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
 
Equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
 
 
 
 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 
https://www.indeedjobs.com/proenlist?hl=en_US
 
 
or
this job portal is powered by CATS