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:
Senior Medical Director Profile:
- 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.
- 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.