Temporary Medical Director

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

We are seeking TWO talented and enthusiastic Medical Directors to join our team on a temporary part-time basis!

Function as an integral part of the HealthCare Management team responsible for Utilization Management, Care Management, and Pharmacy Services programs. Represent HealthCare Management in interdepartmental activities and represent Health Partners in the hospital/health system and provider communities and regulatory and governmental activities. Apply clinical expertise and experience as a provider to promote the proper delivery of medically necessary services to the population served. Perform utilization, pharmacy, and quality reviews.

As the temporary Medical Director, your daily duties may include:

Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. This will include peer-to-peer discussions with providers.

Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee.

Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services.

Participate and/or lead rounds including but not limited to disease management, care management or admissions.

Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs.

Support ongoing activities in OB, pediatric, adolescent, adult preventative, and geriatric care.

Develop and or revise practice guidelines for acute and chronic care.

Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.

Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes.

Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer.

Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer.

Perform other job duties as assigned.

Qualifications

• Medical Physician (MD or DO) required.

• Pennsylvania Medical License without restriction.

• Board Certification in a specialty (primary care preferred)

• Graduate business degree is a plus (MBA, MMM, etc.).

• Minimum 5 years post-residency experience in the clinical practice of medicine.

• Managed care experience, with responsibility for utilization management.

Skills, We Value:

Excellent organizational, interpersonal, time management and communications skills.

Strong leadership skills.

Strong conflict resolution and independent decision-making skills.

Expert project management ability.

Strong influencing, negotiation and analytical skills.

Working knowledge of PC based applications such as Excel, Access and Word.

Knowledge of the principles of Utilization, Quality and Care Management.