- Direct the development of training materials for nurses and physicians.
- Oversee quality assurance of nurse and physician work product.
- Provide advice and counsel to the client as directed.
- Address clinical case questions from Appeals Officers and Administrative staff.
- Provide clinical advice and counsel to the internal team as needed, including assistance with identifying appropriate specialists for cases, addressing the sufficiency of panel physicians analyses, and addressing clinical questions.
- Communicate directly with panel physician reviewers as needed as part of the physician panel oversight function. This may be in the role of coaching, training, or even disciplinary actions.
- Vetting of potential panel physicians recruited by Provider Recruitment and Credentialing (PRC).
- Support the development of training materials for panel physicians and appeals officers.
- Perform quality reviews as requested by the client.
- Serve as the medical expert in ISO and URAC audits.
- Participate in quality improvement initiatives.
- Report to Senior Director or VP level.
- Direct and control the activities of a broad functional area through several department managers within the company.
- Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods.
- Work on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
- Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
- Ensure budgets and schedules meet corporate requirements.
- Regularly interact with executives and/or major customers.
- Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
- Report to Senior Director or VP level.
- Medical degree (MD or DO) with board certification in an ABMS or AOA recognized specialty
- At least 5 years of clinical patient care experience post-board certification
- Licensure, current and unrestricted
- Experience performing independent medical reviews or utilization reviews (at least one year of experience)
- Must be able to successfully pass credentialing requirements
- Knowledge and application of medical management treatment guidelines
- Comfortable reviewing the work of other physicians (all specialties)
- Windows-based computer skills including typing, word processing, presentation, and internet research
- Must NOT be currently employed by a managed health plan
- Prior utilization review work experience in a managed care environment
- Prior experience as a medical director in utilization review
- Proficiency in conflict resolution
- Experience with ISO and URAC certification audits
- Licensure, current and unrestricted, to practice in the state of California
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Medical Director, Part-Time - Gary, United States - MAXIMUS
Description
Description & Requirements
Maximus is currently recruiting for a Part-Time Medical Director This position will support our DMHC Program. This is a part-time, fully remote position that can be located anywhere in the US.
The mission of the California Department of Managed Health Care (DMHC) is to protect consumers health care rights and ensure a stable health care delivery system. The DMHC accomplishes its mission by ensuring the health care system works for consumers. The Department protects the health care rights of more than 29.7 million Californians by regulating health care service plans, assisting consumers through a consumer Help Center, educating consumers on their rights and responsibilities, and preserving the financial stability of the managed health care system.
The work hours for this position are from 3 PM to 8 PM Eastern Standard Time (EST) / 1 PM to 5 PM Pacific Time (PCT). Please note in order to be considered for this position, you must not be currently employed by a managed health plan.
Essential Duties and Responsibilities:
Minimum Requirements
Preferred Qualifications:
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. Were proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.
Annual Base Pay Minimum for this Position
$104.00
Annual Base Pay Maximum for this Position
$121.00
