- Supports the Medical Management staff to ensure timely and consistent responses to members and providers.
- Provides guidance for clinical operational aspects of a program.
- Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.
- May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
- Interprets existing policies or clinical guidelines and develops new policies based on changes in the healthcare or medical arena.
- Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
- Provides expertise, captures and shares best practices across regions to other medical directors.
- May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees.
- Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
- Requires active unrestricted medical license to practice medicine or a health profession.
- Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
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Medical Director
1 week ago
National Medical Association Des Moines, United StatesMedical Director, Inpatient Mental Health Program – Kansas City · Are you looking for an exceptional opportunity and a desire to be a part of the biggest change in behavioral health for youth in the Kansas City area? · Children's Mercy Kansas City, in partnership with Camber Ment ...
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Center Medical Director
1 week ago
Oak Street Health Des Moines, United StatesDescription · Role Description: · The purpose of the Center Medical Director role at Oak Street Health is to lead the clinical team at their center in providing the best patient care and a great place to work in order to keep patients happy, healthy and out of the hospital. The ...
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Associate Medical Director
4 weeks ago
Elevance Health West Des Moines, United States Full timeJob Description · : Clinical Operations Associate Medical Director · Neurosurgery · Carelon Insights/Carelon Medical Benefits Management · A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a ben ...
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Kansas - Northeast - Medical Director
1 week ago
Miner / Mason & Associates Des Moines, United StatesA brand-new freestanding Rehabilitation Hospital in Northeast Missouri is looking for a Medical Director The hospital is expected to serve 650 patients annually, as it will be successful in that they have no immediate competition in the area. The organization truly distinguishes ...
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Emergency Room Medical Director
1 week ago
Veterans Health Administration Des Moines, United States Full timeSummary · The Central Iowa VA Health Care System is currently recruiting for a full time, permanent Emergency Room Medical Director Physician. It is understood the individual will maintain clinical duties. Physicians are to adhere to OPM (Office of Personnel Management), VHA, Med ...
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Emergency Room Medical Director
1 week ago
Veterans Health Administration Des Moines, United StatesSummary The Central Iowa VA Health Care System is currently recruiting for a full time, permanent Emergency Room Medical Director Physician. It is understood the individual will maintain clinical duties. Physicians are to adhere to OPM (Office of Personnel Management), VHA, Medic ...
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Director of Engagement, Medical Advancement
1 week ago
Rome Group Des Moines, United StatesPosition Summary · As an integral member of the Medical Advancement Strategic Engagement team, the Director of Engagement will work closely with the Strategic Engagement team and gift officers to establish a donor centric program that demonstrates impact and recognizes and celeb ...
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Public Health Medical Director Assistant
2 weeks ago
State of Iowa Des Moines, United StatesPublic Health Medical Director Assistant · Salary · $57, $87,734.40 Annually · Location · Des Moines Polk County, IA · Job Type · Full-time · Job Number · Agency · 588 Health & Human Services - Public Health · Opening Date · 05/10/2024 · Closing Date · 5/20/2024 11:59 PM Central ...
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Public Health Medical Director Assistant
1 week ago
Iowa Department of Administrative Services Des Moines, United StatesPublic Health Medical Director Assistant · Print ) · Public Health Medical Director Assistant · Salary · $57, $87,734.40 Annually · Location · Des Moines Polk County, IA · Job Type · Full-time · Job Number · Agency · 588 Health & Human Services - Public Health · Opening Date · ...
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Health medical director
3 weeks ago
Elevance Health Des Moines, United States· 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 is an individua ...
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Medical Director
4 weeks ago
VCA Animal Hospitals, Inc. La Quinta, United StatesVCA Village Park is seeking highly experienced Veterinarian to lead our team as Medical Director to join our progressive, multi-doctor practice in La Quinta, California. This is an outstanding opportunity to continue practicing medicine while establi Medical Director, Director, M ...
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Medical Director
1 week ago
VCA Antech, Inc. La Quinta, United StatesVCA Village Park is seeking highly experienced Veterinarian to lead our team as Medical Director to join our progressive, multi-doctor practice in La Quinta, California. · This is an outstanding opportunity to continue practicing medicine while establishing the direction and medi ...
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Medical Director
1 week ago
VCA Antech, Inc. La Quinta, United StatesVCA All Creatures is seeking highly experienced Veterinarian to lead our team as Medical Director to join our progressive, multi-doctor practice in La Quinta, California. · This is an outstanding opportunity to continue practicing medicine while establishing the direction and med ...
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Medical Director
6 days ago
VCA Antech, Inc. La Quinta, United StatesVCA All Creatures is seeking highly experienced Veterinarian to lead our team as Medical Director to join our progressive, multi-doctor practice in La Quinta, California. · This is an outstanding opportunity to continue practicing medicine while establishing the direction and med ...
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Emergency Room Medical Director
1 month ago
Department Of Veterans Affairs Des Moines, United States Full timeSummary · The Central Iowa VA Health Care System is currently recruiting for a full time, permanent Emergency Room Medical Director Physician. It is understood the individual will maintain clinical duties. Physicians are to adhere to OPM (Office of Personnel Management), VHA, Med ...
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Public Health Medical Director Assistant
3 weeks ago
State of Iowa Des Moines, United StatesPublic Health Medical Director Assistant | Government Jobs page has loaded. · Public Health Medical Director Assistant · Location · Des Moines Polk County, IA · Full-time · Job Number · 588 Health & Human Services - Public Health · Opening Date · 05/10/2024 · 5/20/2024 at 11:59 ...
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Medical Director St. Louis, MO
4 weeks ago
HCRC Staffing Des Moines, United StatesFull time · Great work/life balance with no call, nights, or holidays · We are looking for a physician to join our medical group full time, to provide direct patient care as well as supervision of the PA/NPs on staff at our offices in the St. Louis, MO area. The physician's dut ...
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Humana Des Moines, United StatesBecome a part of our caring community and help us put health first · The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of diverse scope and complexity ranging from modera ...
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FCS - Psychiatric Recruitment Des Moines, United StatesState of the art, major medical facility located in Des Moines, IA, is seeking a Medical Director. Great pay and benefits Des Moines has been named by Forbes as the Best City for Young Professionals and Parenting Magazine has ranked it at for best city for families - based on gre ...
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Medical Director
2 weeks ago
Intermountain Health Nevada, United StatesJob Description: · Scope · Medical Director Pediatrics will work collaboratively in a dyad/triad partnership to define, establish, and oversee the work of Intermountain Pediatrics, working collaboratively with all disciplines including specialty care, community care, clinical pr ...
Plan Performance Medical Director - Des Moines, United States - Elevance Health
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Description
ThePlan Performance Director
is responsible for serving as the lead clinician for a plan.
Responsible for the administration of medical services for company health plan including the overall medical policies or clinical guidelines of the plan to ensure the appropriate and most cost-effective medical care is received.
Drives direction of the plan related to cost of care and other plan directives. Works with the market plan president during meetings with State Regulator.Location:
This is a hybrid position and will require 1 day per week in the St. Louis office.
How you will make an impact:
Minimum Requirements: