- Monitoring the level of care using both statistical information and chart review and may offer unsolicited medical judgment when appropriate
- Monitoring the use of medical services, and has the authority to issue denials of service deemed appropriate
- Oversees Utilization Management Programs and may oversee Quality Improvement Programs
- Oversee, implement, and constantly update utilization management policies for referrals and medications for cost-effectiveness.
- Serves as a clinical resource for senior administrative management and case managers.
- Assists in the development and implementation of "best practice patterns" in the form of both medical protocols and process management protocols
- Participates in the review and assessment, and provides advice on complex, controversial, and/or unique claims that are outside the realm of medical policy, including solicitation and evaluation of advice from outside medical consults and physicians concerning complex, controversial, experimental and/or innovative techniques
- Provides medical expertise and support to ensure appropriate care and services through a continuum between hospitals, skilled nursing facilities, and home care to ensure quality and continuity of care for complex case management
- Facilitate conformance with DHS, DMHC, NCQA, and other regulatory requirements
- Evaluate referral authorization requests in support of nurse reviewers and manage the denial process
- Teaching and administration of charts review for Family Nurse Practitioners and Physician Assistants.
- Supervises, advises and trains clinical professionals and/or students in areas of expertise.
- At least three (3) years of experience as a Medical Doctor
- At least 10 years of experience as a medical provider
- Board Certified Family Practice / Internal Medicine Physician
- ACLS or CPR / AED Certified
- Current medical license to practice, without restrictions, in Florida
- Education, training, or experience related to NCQA, QM, multi-specialty group practice, and HMO industry
- Broad knowledge base regarding managed care systems, quality improvement, medical utilization, and risk management
- Must be analytical, results-oriented, able to establish priorities, and respond to requests for assistance, guidance, or decision-making on time
- Preferably free from any insurance exclusivity agreement.
- Experience in EMR/EHR is highly preferred
- Able to work in Homestead, FL
- Bilingual (English/Spanish) is highly preferred.
-
Medical Director
3 weeks ago
Miami Children's Homestead, United StatesOutstanding Opportunity for Pediatric Emergency Medicine Medical Director In Miami · Nicklaus Children's Pediatric Specialists (NCPS), the physician multispecialty group practice of Nicklaus Children's Health System, have an exceptional opportunity for a fellowship-trained BC/BE ...
-
Medical Director
1 day ago
Nicklaus Children's Hospital Homestead, FL, United StatesDescription · Outstanding Opportunity for Pediatric Emergency Medicine Medical Director In Miami · Nicklaus Children's Pediatric Specialists (NCPS), the physician multispecialty group practice of Nicklaus Children's Health System, have an exceptional opportunity for a fellowship ...
-
Medical Director
3 weeks ago
Nicklaus Children's Hospital Homestead, FL, United StatesOutstanding Opportunity for Pediatric Emergency Medicine Medical Director In Miami Nicklaus Children's Pediatric Specialists (NCPS), the physician multispecialty group practice of Nicklaus Children's Health System, have an exceptional opportunity for a fellowship-trained BC/BE pe ...
-
Medical Director
2 weeks ago
Hayman Daugherty Associates, Inc Miami, United StatesJob Overview · Seeking a Medical Director specializing in Obstetrics and Gynecology to join a practice in Florida. Minimum of 3 years post-residency OB/GYN experience. Medical Spanish is helpful. Leadership experience required. Active/current skills. Active FL licensure. Board ce ...
-
Medical Director
2 weeks ago
University of Miami Miami, United StatesCurrent Employees: · If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here $) to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please re ...
-
Emergency Medicine, Clinical Medical Director
3 weeks ago
Nicklaus Children's Hospital Homestead, FL, United States Full timeOutstanding Opportunity for Pediatric Emergency Medicine Medical Director In Miami · Nicklaus Children's Pediatric Specialists (NCPS), the physician multispecialty group practice of Nicklaus Children's Health System, have an exceptional opportunity for a fellowship-trained BC/BE ...
-
Medical Director
2 weeks ago
AIDS Healthcare Foundation Miami, United StatesWHO WE ARE · AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare FoundationDoes the idea of doing something that really makes a difference in people's lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growt ...
-
Medical Director
3 weeks ago
AIDS Healthcare Foundation Miami, United StatesJob Description · Job DescriptionOverview · AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation · Does the idea of doing something that really makes a difference in people's lives while being well-compensated intrigue you? Are you looking to work for an ...
-
UM Medical Director
4 weeks ago
Elevance Health Miami, United States Full timeJob Description · : Wellpoint, formerly Amerigroup, is a proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also provide administrative services to Medicaid plans in partnership with blue cross blue shield plans. · This ...
-
Chief Medical Director
3 weeks ago
State of Kansas Miami County, United StatesEmployment Benefits · : Comprehensive medical, mental, dental, vision, and additional coverage · Sick & Vacation leave · Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave · Paid State Holidays (designated by the Governor annually) · Employee d ...
-
Associate Medical Director
1 day ago
Nicklaus Children's Hospital Miami, FL, United StatesDescription · Outstanding Opportunity for Associate Medical Director of Quality · Nicklaus Children's Pediatric Specialists · Community Emergency Departments · Nicklaus Children's Pediatric Specialists (NCPS), the physician multispecialty group practice of Nicklaus · Children's H ...
-
Medical Director Physician
4 weeks ago
Familiar Medical Center Doral, United StatesJob Description · Job Description · We are seeking a Medical Director Physician to become a part of our team You will coordinate medical and health services in clinics or similar organizations. · Responsibilities: · Oversee medical and health service activities and personnel · ...
-
Senior Medical Director
3 weeks ago
Palm Medical Centers Miami, United StatesJob Description · Job DescriptionOverview · We are seeking a highly experienced and dynamic Senior Medical Director to join the executive leadership team and to lead clinical operations for Palm Medical Centers (Palm). The Senior Medical Director will be responsible for setting t ...
-
Medical Director Physician
3 weeks ago
Familiar Medical Center Miami, United StatesJob Description · Job DescriptionWe are seeking a Medical Director Physician to become a part of our team You will coordinate medical and health services in clinics or similar organizations. · Responsibilities: · Oversee medical and health service activities and personnel · Plan ...
-
Director, Continuing Medical Education
2 weeks ago
InsideHigherEd Coral Gables, United States OTHERCurrent Employees:If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review th ...
-
Director, Continuing Medical Education
2 weeks ago
InsideHigherEd Coral Gables, United States OTHERCurrent Employees:If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review th ...
-
Medical Director
3 weeks ago
Hayman Daugherty Associates Doral, United StatesJob Overview · Seeking a Medical Director specializing in Obstetrics and Gynecology to join a practice in Florida. Minimum of 3 years post-residency OB/GYN experience. Medical Spanish is helpful. Leadership experience required. Active/current skills. Active FL licensure. Board c ...
-
Medical Director
2 weeks ago
Korn Ferry Doral, United StatesThe Department of Surgery –Transplant Lab has an exciting opportunity for Associate Director of Medical Transplant Lab – Open Rank clinical faculty member. · Job Functions: · The associate director will work under the supervision of the interim medical director with the potential ...
-
Medical Director
3 weeks ago
ChenMed Careers Miami, FL, United States Full timeWe're different than most primary care providers. The Care Supervisor is a healthcare and leadership-focused position working directly with patients and their families, doctors and other medical personnel in a dynamic and professional environment to provide the highest level of q ...
-
Director Medical
3 weeks ago
Jobot Miami, FL, United StatesLooking to hire an Audit Director/Partner - HYBRID · This Jobot Job is hosted by: Tiffany Cobian · For over thirty years, we have provided high-quality financial and management services to a diverse and successful client base. We are dedicated to helping our clients develop thr ...
Medical Director - Homestead, United States - Nexus HR Services
Description
Job Description
Job DescriptionMedical Director - Homestead, FL 33032
Compensation: $165k
Overview: Nexus HR is looking for a passionate and dedicated Medical Director who actively seeks new ways of exceeding the expectations of patients, families, caregivers, support persons, and co-workers, for a reputable medical center in Homestead, Florida.
Client-highlighted qualifications - 5 to 8 years of medical experience, with at least 2 years of medical directorship experience, a medical license in Florida, a strong foundation in primary care and geriatric care
About the Job
The Medical Director will provide medical and clinical oversight and maintain the medical management to ensure quality healthcare is provided
Duties and Responsibilities:
Qualifications: