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Senior Medical Director

North Seattle, WA · Healthcare
Senior Medical Director - Health Plan
North Seattle, WA  (Northern Suburb near Lynwood)
 
 *** Generous Relocation Package available to attract top talent from around the Nation! ***
 
Senior Medical Director Job Summary: 
 
  • Serves as the primary liaison between administration and medical staff.
  • Assures the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services.
  • Maintains a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff.
  • Improves quality and inter-rater reliability of clinical decisions.
  • Ability to establish self as a credible subject matter expert while developing effective working relationships.
  • Designs Medical Director training materials: onboarding materials and topic specific materials.
  • Creates structure and program for Medical Director training, auditing, and testing for the health plans and for the central units.
  • Analyzes data and identifies medical cost savings and quality improvement opportunities.
  • Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators.
  • Directs the team in providing physician leadership and expertise in the performance of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities.
  • Ensures that authorization decisions are rendered by qualified medical personnel, without hindrance due to fiscal or administrative incentives.
 
 
Senior Medical Director Profile: 
 
  • Formal education including a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
  • Master's in Business Administration, Public Health, Healthcare Administration is a plus.
  • Must hold and maintain an active unrestricted state license to practice medicine.
  • At least 5 years directly applicable clinical practice experience in the US, and board certification or eligible.
  • Around 3 years of experience working for a Managed Care Organization (Health Plan/IPA/HMO/TPA, etc), ideally as a Medical Director or Senior Program Manager.
  • At least 1-2 years using evidence based clinical criteria.
  • At least 2 years prior supervisory experience.
  • Requires prior experience with peer review, medical policy/procedure development, provider contracting experience.
  • Demonstrated ability to communicate and educate providers regarding principles of Utilization Management and Quality Improvement.
  • Excellent written and verbal communication skills; and strong critical thinking, deductive reasoning and decision-making skills are needed.
  • Ability to implement complex programs and to monitor implementation and modifications. 

#Clinical
 
RON AMODIO
STRATEGIC DIRECTOR, EXECUTIVE SEARCH DIVISION

CareNational
ron@carenational.com
480.269.9491 (CALL – TEXT – FAX)
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