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Medical Director

Company:
ALC Staffing Associates
Location:
Columbia, South Carolina, United States
Salary:
$190K-$250K
Posted:
November 14, 2016
Description:

Medical Director

Candidate must be an actively practicing physician

Columbia, SC

Salary: $190K-$250K + 20% Bonus

Relocation Assistance Available

Job Description:

I am looking to recruit a Physician to assist my clients Chief Medical Director in order to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.

This candidate must be qualified and able to provide medical leadership of all for utilization management, cost containment, and medical quality improvement activities as well as the following:

Perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.

Support effective implementation of performance improvement initiatives for capitated providers.

Assist Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.

Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.

Assist the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.

Oversee the activities of physician advisors.

Utilize the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.

Participate in provider network development and new market expansion as appropriate.

Assist in the development and implementation of physician education with respect to clinical issues and policies.

Identify utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.

Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.

Have the ability to interface with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.

Review claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.

Develop alliances with the provider community through the development and implementation of the medical management programs.

As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.

Represents the business unit at appropriate state committees and other ad hoc committees.

Qualifications:

*Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).

*Candidate must be an actively practicing physician.

*Previous experience within a managed care organization is preferred.

*Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.

*Experience treating or managing care for a culturally diverse population preferred.

*Board Certification through American Board Medical Specialties.

*Current state medical license without restrictions.

My client is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable.