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Job Summary
The Senior Medical
Director is responsible for supervising Medical Directors and Medical Policy
development/implementation, providing and supervising prior authorization
decisions, clinical appeal decisions, participation in peer-to-peer physician
calls, and leading clinical rounds with nursing staff. Responsibilities
also include maintaining relationships with self-funded employer groups which
may require limited travel to our clients in Washington and other states. In
addition, it?s an opportunity to work with the Chief Medical Officer and senior
management team in strategic planning. This position provides an excellent
opportunity to grow and develop Chief Medical Officer knowledge and skills.
Main Duties
Provide timely Utilization Management, Case Management, and Behavioral Health support: case reviews, appeals, physician calls, clinical rounds, daily operations.
Maintain accountability for Medical programs and associated data collection and reporting requirements.
Provide leadership and accountability for efficient, timely, and evidence-based medical policy development.
Provide clinical oversight and act as liaison to Pharmacy Benefit Services.
Assist with Utilization Management, Case Management, and Behavioral Health Policy and Procedure enhancements, educational rounds, and other activities to maintain Health Utilization Management and Case Management URAC Accreditations.
Provide Medical Director expertise and support for QI projects to meet or exceed URAC standards.
Assist in evaluation of quality of care concerns or complaints.
Support or chair select committees as identified by CMO, including but not limited to: Medical Policy, Payment Policy, Appeals, Credentialing, Healthcare Analytics, Medical Advisory, and ad hoc committees.
Provide marketing support as requested.
Participate in community activities as identified.
Coordinate with VP of Medical Management to ensure adequate support of Medical Management Department.
Coordinate with VP of PPO Ops to ensure adequate support of Credentialing.
Other duties as assigned.
Requirements
The ideal candidate will have:
Leadership experience, medical director experience in utilization management in a TPA, and a minimum of ten years of clinical experience. Strong organizational, communication, analytical, management, presentation and negotiation skills. Knowledge of quality, healthcare reform, value-based care, contracting and payor relations, risk management, and clinical innovation.
Current, active, unrestricted license to practice medicine in Washington State and residing in the Puget Sound area.
Current
ABMS board certification in a clinical specialty, preferably Family Practice,
Internal Medicine, or Emergency Medicine.
Minimum
5 years of clinical practice experience.
Experience
as a medical director, preferably in a medium sized TPA, health plan or managed
care group.
History
of work in Quality, Utilization Management, Case Management, Claims Review,
Medical Policy and Implementation, and working with regulatory bodies such as
URAC.
6Experience
in managing physicians - employed and/or contracted.
Our Benefits
Become a First Choice Health employee and enjoy our generous benefit package. We offer competitive benefits that are much beyond the traditional basics.
Click here to learn more about our competitive benefit package.How to Apply
Please submit your resume to jobs@fchn.com.
Additional information about our company may be found on our website www.fchn.com