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Part-Time Medical Director (Case Review & Clinical Operations)

Company Name:
Medica
Title: Part-Time Medical Director (Case Review & Clinical Operations)
Location: null
Other Locations: null
What you''ll get to do:
The Medical Director - Clinical Operations has the responsibilities of supporting care management, quality, utilization management, credentialing, pharmacy, health policy implementation, technology assessment and risk management activities. This position requires a solid medical and business mind, with strong judgment and investigative nature, and an ability to develop medical policy that effectively balances provider, patient, and health plan interests. This person also works to bring consistency to all aspects of the decision-making surrounding the above noted activities.
This particular opportunity is part-time, 8 hours per week, Mondays & Tuesdays preferred.
Key Accountabilities:
Care Management and Appeals Decisions Participation
Care Management Program and Initiatives Participation
Quality of Care Complaints Participation
Reimbursement Policies For Clinical Services
Claims Expenditures
Committee Participation
Qualifications:
Bachelors and medical degrees required
Must be a licensed physician with current Board certification; current license to practice must be without restrictions.
Specific types of experience:
5 years experience in health care, including leadership in a delivery system/hospital
5 years experience in the clinical practice of medicine
Required Certifications/Licensure:
Licensed Physician
Skills and Abilities:
Demonstrated proficiency in pre-service review, concurrent review, post-service review, case management and appeals (excellent case investigation skills
Knowledge of pharmacy and therapeutics process, including prior experience in formulary development and utilization review is very desirable
Outstanding written, verbal and communications skills
Strong collaboration skills
Technical aptitude
Ability to represent Clinical on various Medica Committees
Strong process management skills
Strong ability to utilize various application technology systems
Excellent leadership skills
Customer service orientation - must enjoy speaking to network physicians
Actively influences and drives discussions toward resolution - shows good judgment and decisiveness
Equal Opportunity Employer including Veterans and Disabled Individuals
Thrive Together.
At Medica, you''ll enjoy working with talented people who share a mission to meet our customers'' needs.
Grow Together.
Medica will support you through your personal growth and involvement in the community.
Succeed Together.
Medica provides resources that allow you to take charge of your health and career.
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