- Oversee and have accountability for the medical review activities of the organization or assigned contracts.
- Conduct critical peer reviews to ensure the health provided is appropriate and necessary.
- Instruct other physician reviewers on critical reviews and improvement of health care.
- Assist Telligen staff with training physician reviewers regarding their responsibilities and functions.
- Serve as a technical expert on the peer review process.
- Participate in advisory panels as recommended.
- Represent Telligen policies and procedures to medical and non-medical persons.
- Participate in committee meetings representing Telligen.
- Current unrestricted MD or DO license in the state of Mississippi
- Current and active, unrestricted United States board certification by the American Board of Medical Specialties or Advisory Board of Osteopathic Medicine.
- Post-graduate experience in direct clinical patient care.
- Experience with Medicaid is highly preferred.
- 3+ years of managing and/or working with Medicaid, government health plans, or authorization programs is required.
- If remote: must be willing to travel regularly to our Jackson Mississippi office.
- We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories.
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Quality Medical Director - Ridgeland, United States - Telligen
Description
Quality Medical DirectorAs the Quality Medical Director, you will oversee Telligen's Mississippi Quality Assurance team to ensure the proper provision of program services. You will serve as a clinical liaison for quality management and improvement activities for the FFS and MississippiCAN programs, located at the DOM Central office, and shall work during normal business hours of DOM. The Quality Medical Director shall not be an active Medicaid Provider.
Essential Functions
As part of our commitment to health and safety, some roles may require additional health protocols (i.e. personal protective equipment or vaccination)
Who We Are:
Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.
Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions.
Our business is our people and we're looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at
Are you Ready?
We're on a mission to transform lives and economies by improving health and getting there means following through on our values of Ownership, Community, Ingenuity & Integrity.
Ownership: As a 100% employee-owned company, our employee-owners drive our business, our solutions, and share in our success. When employee-owners grow and thrive, we all win.
Community: Putting others first and being a good corporate partner wherever we work, and play makes us who we are. We Show Up. For our clients, for our communities, and for each other.
Ingenuity: We're a team of passionate professionals driven by hard work and big ideas. We understand that high-value breakthroughs come from taking calculated risks. If it will benefit our clients and advance our mission, we're all ears. We celebrate free-thinking and challenge the status quo, so brainstorm away
Integrity: Smiling faces (virtual or in-person) are the norm around here. We enjoy a friendly work environment where everyone is dedicated to mutual trust, respect, and excellence.
Thank you for your interest in Telligen
Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.
Telligen and our affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability), and E-Verify Participants.
Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time.
Telligen does not accept 3rd party solicitations from outside staffing firms.
