The Medical Director of Care Management is responsible for long and short term Managed Care initiatives, including the design, implementation and oversight of Utilization Review, Case Management and Quality Management programs that will ensure quality healthcare in a large Southwestern community.
The position will serve as a valuable clinical resource for information and consultation on issues related to utilization of clinical care services, medical management policy, quality of care practice guidelines and clinical review of technology.
Other accountability will be implementing continuous quality improvement and educational programs for Providers, developing procedures/guidelines for managing the clinical and financial risk of coordinated, managed care, overseeing quality accreditation initiatives and participating in the development of quality and productivity incentive programs for Providers. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.
Required: Fully licensed as a physician.
Preferred: Master’s Degree in related filed
Required: Two (2) years’ experience at senior leadership level in medical group or network; Five (5) years’ experience as a practicing physician preferably in a medical group. Preferred-Experience in both fee-for-service and managed care operations.
Excellent communication skills, both verbal and written. Ability to comfortably use Microsoft Word, Excel, and PowerPoint. Thorough understanding of medical group business models and clinical processes. Excellent understanding of medical group financial concepts, including revenue cycle, physician compensation models, and preferably including managed care financial concepts (capitation, IBNR, MLR).
Required: Current MD/DO medical license. Board Certified in Specialty or Primary Care, or in the process of obtaining certification unless granted an exemption by Credentialing Committee and/or Board of Governors. Qualified to receive Pharmacy/DEA Registration if applicable to practice Preferred- Current BLS Certification.
Internal Number: 2019
BACK TO TOP
NAHQ Career Center is Just One of the Benefits.
Discover what else NAHQ Membership has to offer!
The job you are trying to reach from was originally posted at NAHQ Career Center.