Description:
MEDICAL DIRECTOR Oversees the medical management programs for assigned business sector. Provides medical leadership toensure excellent quality of care and service is provided to our members/clients that is efficient and costeffective. Experience working with Medicaid required.
ESSENTIAL RESPONSIBILITIES
� Provides technical expertise in medical management by direct decision making in the areas of preauthorization;concurrent review of hospitalized patients; discharge planning; complex case and chroniccare management; and credentialing.� Oversees the clinical aspects of the quality management; credentialing; pharmacy; and medicalmanagement program.� Chairs (or staffs) all peer-review committees such as Quality Improvement; Pharmacy and Therapeutics;Credentialing; and others that are deemed appropriate for the health plan. May participate in thePhysicians Advisory Committee. Takes part in periodic consultations and/or conversations with peersand practitioners in the field.� Analyzes medical cost drivers and develops specific plans to reduce excessive cost.� Works with senior leadership to develop strategic approaches to improve company performance andexpand growth by optimizing provider network; evaluating provider (hospital; physician; ancillary)contracts; and developing other creative approaches.� Provides oversight for all quality improvement projects.� Provides oversight for all accreditation activities (URAC and/or NCQA) within the assigned businesssector.� For Medical Directors with senior clinical staff responsibilities; ensures a staff of qualified cliniciansaccountable to the organization for decisions affecting consumers is maintained; and that appeals arereviewed by non-subordinate board certified specialists.� Recruits; develops; and motivates staff. Initiates and communicates a variety of personnel actionsincluding employment; termination; performance reviews; salary reviews; and disciplinary actions.� Performs other duties as required.JOB SPECIFICATIONS� Formal education including an MD or DO degree.� Employee must hold and maintain an active unrestricted license to practice medicine.� Board certified with post residency experience preferably in primary care specialty.� Board certification may be waived for a part-time Medical Director who will not function in the capacity ofa senior clinical staff person.� Previous (2 years) managed care experience as a Medical Director or equivalent.� Excellent clinical knowledge and skills.� Strong written and verbal communication skills.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer; and we are committed to building a talented and diverse team.
Qualifications:
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Pittsburgh, PA, US
Other Locations: ,
Organization: 23000 - HealthAmerica Pennsylvania Inc
Schedule: Full-time
Job Posting: 2013-09-12 00:00:00.0
Job ID: 174299k
MEDICAL DIRECTOR Oversees the medical management programs for assigned business sector. Provides medical leadership toensure excellent quality of care and service is provided to our members/clients that is efficient and costeffective. Experience working with Medicaid required.
ESSENTIAL RESPONSIBILITIES
� Provides technical expertise in medical management by direct decision making in the areas of preauthorization;concurrent review of hospitalized patients; discharge planning; complex case and chroniccare management; and credentialing.� Oversees the clinical aspects of the quality management; credentialing; pharmacy; and medicalmanagement program.� Chairs (or staffs) all peer-review committees such as Quality Improvement; Pharmacy and Therapeutics;Credentialing; and others that are deemed appropriate for the health plan. May participate in thePhysicians Advisory Committee. Takes part in periodic consultations and/or conversations with peersand practitioners in the field.� Analyzes medical cost drivers and develops specific plans to reduce excessive cost.� Works with senior leadership to develop strategic approaches to improve company performance andexpand growth by optimizing provider network; evaluating provider (hospital; physician; ancillary)contracts; and developing other creative approaches.� Provides oversight for all quality improvement projects.� Provides oversight for all accreditation activities (URAC and/or NCQA) within the assigned businesssector.� For Medical Directors with senior clinical staff responsibilities; ensures a staff of qualified cliniciansaccountable to the organization for decisions affecting consumers is maintained; and that appeals arereviewed by non-subordinate board certified specialists.� Recruits; develops; and motivates staff. Initiates and communicates a variety of personnel actionsincluding employment; termination; performance reviews; salary reviews; and disciplinary actions.� Performs other duties as required.JOB SPECIFICATIONS� Formal education including an MD or DO degree.� Employee must hold and maintain an active unrestricted license to practice medicine.� Board certified with post residency experience preferably in primary care specialty.� Board certification may be waived for a part-time Medical Director who will not function in the capacity ofa senior clinical staff person.� Previous (2 years) managed care experience as a Medical Director or equivalent.� Excellent clinical knowledge and skills.� Strong written and verbal communication skills.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer; and we are committed to building a talented and diverse team.
Qualifications:
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: Pittsburgh, PA, US
Other Locations: ,
Organization: 23000 - HealthAmerica Pennsylvania Inc
Schedule: Full-time
Job Posting: 2013-09-12 00:00:00.0
Job ID: 174299k