Medical Director Needed in Southwest Ohio!
, OH, United States
Medical Director Needed in Southwest Ohio!! Medical Director Needed in Southwest Ohio!!
Job Summary
We are looking for a Market Medical Director who will be responsible for establishing strong collegial relationships with participating health plan physicians in each of his/her markets. Utilizing these relationships as well as available data, the Market Medical Director works to positively impact the quality and efficiency of care received by health plan members in each of these markets. The Market Medical Director will serve as the main liaison between the health plan and the provider community for all clinical issues.
What We Are Looking For:
Population Health – collaborative care management leadership
•Provides clinical leadership and development for a population health programs or functional area within Medical Management, e.g, patient centered medical home, health and wellness, population management, high risk care management, reporting capability, etc.
•Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
•Helps recruit, develop and motivate population health-care management staff
•Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers
•Stratification, continuous evaluation and re-stratification of population for appropriate resource allocation
Physician and provider relationship management
•Responsible leading change with physicians and other providers, especially the practices, to improve the quality and efficiency of care in the network and integrate these providers into our clinical initiatives.
•Visits network facilities on a regular basis, identifies key issues facing leaders and works collaboratively with leadership to accomplish mutually agreed upon goals.
•Creates and maintain a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
•Nurtures a culture where delivering the highest quality yields lowest cost
•Participates in the development of physician incentives and gain sharing arrangements.
•Develop, maintain and grow relationships with key clinical leaders with the assigned market.
•Develops and executes market specific cost improvement initiatives
Quality of care and service delivery
•Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
•Maintains up-to-date knowledge of new information and technologies in medicine
•Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols
•Chairs or staffs peer review committees and
•Participate in the Appeals and Grievance process, as necessary, to assure timely, accurate responses to members
•Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.
Minimum Required Education, Experience and Skills
•Graduate of an accredited medical school, M.D.OR D.O. Degree is required
•Board Certified by ABMS recognized medical specialty organization
•3-5 years of clinical practice experience
•3 or more years of experience as a physician executive managing physician relationships
•3 or more years as a physician executive working at least part time on utilization management
•Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.
•A thorough understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
•Excellent interpersonal, verbal, and written communication skills.
•Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.
•Ability to navigate in a corporate matrix environment.
Preferred Education, Experience and Skills
•2 or more years managed care of payor experience
•Board certification in internal medicine or family practice
Physical and Mental Requirements
•Ability to sit for extended periods of time
•Ability to properly drive and operate a vehicle
•Ability to receive and comprehend instructions verbally and/or in writing
•Ability to use logical reasoning for simple and complex problem solving
**The material listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.**
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Addiction Medicine Jobs Allergy and Immunology Jobs Anesthesiology Jobs Bariatric Surgery Jobs Breast Surgery Jobs Cardiology (Interventional) Jobs Cardiology (Invasive) Jobs Cardiology (Non-Invasive) Jobs Cardiothoracic Surgery Jobs Cardiovascular Surgery Jobs Child/Adolescent Psychiatry Jobs Colon and Rectal Surgery Jobs Critical Care Medicine Jobs CRNA Jobs Dentist Jobs Dermatology Jobs Electrophysiology Jobs Emergency Medicine Jobs Endocrinology Jobs ENT Jobs Facial Plastic Surgery Jobs Family Practice Jobs Foot/Ankle Surgery Jobs FP/OB Jobs Gastroenterology Jobs General Practice Jobs General Surgery Jobs Geriatrics Jobs Gynecology Jobs Gynecology/Oncology Jobs Hand Surgery Jobs Hematology/Oncology Jobs Hospitalist Jobs Infectious Disease Jobs Internal Medicine Jobs Maternal-Fetal Medicine (Perinatology) Jobs Med/Peds (Internal Medicine & Pediatrics) Jobs Medical Director Jobs Neonatology Jobs Nephrology Jobs Neurological Surgery Jobs Neurology Jobs Nurse Practitioner Jobs OB/GYN Jobs Occupational Medicine Jobs Oncology Jobs Ophthalmology Jobs Oral/Max Surgery Jobs Orthopedic Surgery Jobs Pain Medicine Jobs Palliative Care Jobs Pathology Jobs Pediatric Surgery Jobs Pediatrics Jobs Physical Medicine and Rehab Jobs Physician's Assistant Jobs Plastic Surgery Jobs Podiatry Jobs Psychiatry Jobs Pulmonary/Critical Care Jobs Radiation Oncology Jobs Radiology (Interventional) Jobs Radiology Jobs Reproductive Endocrinology Jobs Rheumatology Jobs Sleep Medicine Jobs Spinal Cord Injury Jobs Spine Surgery Jobs Sports Medicine Jobs Surgical Oncology Jobs Thoracic Surgery Jobs Total Joint Surgery Jobs Trauma Surgery Jobs Urgent Care Medicine Jobs Urogynecology Jobs Urology Jobs Vascular Surgery Jobs Wound Care Jobs
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