Medical Director – Managed Care Plans

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 5,001-10,000H1B SponsorCompany SiteLinkedIn

Location

Pennsylvania

Posted

5 days ago

Salary

0

Seniority

Lead

Postgraduate Degree5 yrs expEnglish

Job Description

Medical Director – Managed Care Plans

Jefferson

• Shape the future of healthcare delivery across one of the nation’s leading academic health systems. • Lead clinical strategy and utilization management for our integrated health plans and care management programs. • Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. • Conduct peer-to-peer discussions with providers. • Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee. • Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services. • Participate and/or lead rounds including but not limited to disease management, care management or admissions. • Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs. • Develop and or revise practice guidelines for acute and chronic care. • Develop and implement policies and procedures required to promote effective utilization management and achieve established targets. • Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes. • Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer. • Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer. • Perform other job duties as assigned.

Job Requirements

  • Medical Physician (MD or DO) required
  • Pennsylvania Medical License without restriction
  • Board Certification in a specialty (primary care preferred)
  • Graduate business degree is a plus (MBA, MMM, etc.)
  • Minimum 5 years post-residency experience in the clinical practice of medicine
  • Managed care experience, with responsibility for utilization management
  • Excellent organizational, interpersonal, time management and communications skills
  • Strong leadership skills.
  • Strong conflict resolution and independent decision-making skills
  • Expert project management ability
  • Strong influencing, negotiation and analytical skills
  • Working knowledge of PC based applications such as Excel, Access and Word
  • Knowledge of the principles of Utilization, Quality and Care Management.

Benefits

  • medical (including prescription) insurance
  • supplemental insurance
  • dental insurance
  • vision insurance
  • life and AD&D insurance
  • short- and long-term disability
  • flexible spending accounts
  • retirement plans
  • tuition assistance
  • access to group rates on insurance and discounts
  • tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
  • access to medical (including prescription) insurance for all colleagues, including those who work less than part-time

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