Description: Our client is currently seeking a Remote Medical Director.
Please send your resume to Isabel Angelichio - iangelichio@judge.com for immediate consideration!
Location: Remote
Hours: 8:00 AM - 5:00 PM CENTRAL
Type of Engagement: Contract
This job will have the following responsibilities:
Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values.
Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities.
Develops strategies for improving all aspects of market performance including RAPS, membership, and medical management.
Participates in case review and medical necessity determination.
Conducts post service reviews issued for medical necessity and benefits determination coding.
Analyzes aggregate data and reports to primary care physician.
Serves as the liaison between physicians and health plan Medical Directors.
Supervises the functions of Care Coordination.
Assesses the effectiveness of the specialty network to ensure members have access to multi specialties within their demographic area.
Represents the providers as an influence to the credentialing committee.
Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process.
Educates primary care network and assists in problem resolution.
Assists in development of medical management protocols.
Performs analysis of utilization data and suggests/implements corrective action plans with network physicians.
Performs all other related duties as assigned.
Customer Service
Oversees and insures physician compliance with UM plan.
Evaluates performance of physicians in regards to established goals and objectives of the company.
Qualifications & Requirements:
Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree required.
Board Certified Family Practitioner or Internal Medical Specialist required.
Unrestricted licensed in Texas, Florida, Georgia, or New Jersey required.
Five or more years of clinical practice experience required.
Two or more years of experience in utilization management activities required.
Proficiency with Microsoft Office applications required.
Preferred Education, Experience & Skills:
Two years of experience with acute admission experience preferred.
Two years of experience working in a managed care health plan environment preferred.
Unrestricted license in New Mexico preferred (in addition to above).
Bilingual (English/Spanish) fluency preferred.
Please send your resume to Isabel Angelichio - iangelichio@judge.com for immediate consideration!
Thank you, I look forward to hearing from and working with you!
Contact: iangelichio@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
