logo

View all jobs

Medical Director

North Seattle, WA · Healthcare
Medical Director - Health Plan
North Seattle, WA  (Northern Suburb near Lynwood)
 
 *** Generous Relocation Package available to attract top talent from around the Nation! ***

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.
  • Expertise in Medicare as it relates to Utilization Management and Appeals standards, processes and policies, and Medicare STARS.
  • Collaborates with the national Medicare team.
  • Facilitates conformance to regulatory requirements.
  • Reviews quality referred issues, focused reviews and recommends corrective actions.
  • Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency and continuity of care.
  • Develops and implements medical policies.
  • Conducts retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.
 
Medical Director Profile: 
 
  • Formal education including a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
  • Must hold and maintain an active unrestricted state license to practice medicine.
  • At least 5 years directly applicable clinical practice experience, and board certification, in the US.
  • Around 2 years of Medical Director experience working for a Managed Care Organization (Health Plan/IPA/HMO/TPA, etc).
  • At least 3 years of Utilization Review /Quality Management program management
  • Requires expertise in Medicare as it relates to Utilization Management and Appeals standards, processes and policies, and Medicare STARS.
  • Demonstrated ability to communicate and educate providers regarding principles of Utilization Management and Quality Improvement.
  • Prefer prior experience with peer review, medical policy/procedure development, provider contracting experience.
  • 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)
See the latest @
CareNational Media!
More Openings
HR Coordinator
HEDIS Coordinator
Share This Job
Powered by