Job Description:
Location: REMOTE
Salary: $112.00 USD Hourly - $115.00 USD Hourly
Description: Our client is currently seeking a Remote Medical Director.
Please send your resume to Isabel Angelichio - iangelichio@judge.com for immediate consideration!
Location: Remote
Hours: 8:00 AM - 5:00 PM CENTRAL
Type of Engagement: Contract
This job will have the following responsibilities:
- Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values.
- Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities.
- Develops strategies for improving all aspects of market performance including RAPS, membership, and medical management.
- Participates in case review and medical necessity determination.
- Conducts post service reviews issued for medical necessity and benefits determination coding.
- Analyzes aggregate data and reports to primary care physician.
- Serves as the liaison between physicians and health plan Medical Directors.
- Supervises the functions of Care Coordination.
- Assesses the effectiveness of the specialty network to ensure members have access to multi specialties within their demographic area.
- Represents the providers as an influence to the credentialing committee.
- Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process.
- Educates primary care network and assists in problem resolution.
- Assists in development of medical management protocols.
- Performs analysis of utilization data and suggests/implements corrective action plans with network physicians.
- Performs all other related duties as assigned.
- Customer Service
- Oversees and insures physician compliance with UM plan.
- Evaluates performance of physicians in regards to established goals and objectives of the company.
- Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree required.
- Board Certified Family Practitioner or Internal Medical Specialist required.
- Unrestricted licensed in Texas, Florida, Georgia, or New Jersey required.
- Five or more years of clinical practice experience required.
- Two or more years of experience in utilization management activities required.
- Proficiency with Microsoft Office applications required.
Preferred Education, Experience & Skills:
- Two years of experience with acute admission experience preferred.
- Two years of experience working in a managed care health plan environment preferred.
- Unrestricted license in New Mexico preferred (in addition to above).
- Bilingual (English/Spanish) fluency preferred.
Please send your resume to Isabel Angelichio - iangelichio@judge.com for immediate consideration!
Thank you, I look forward to hearing from and working with you!
Contact: iangelichio@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
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