Medical Director – Managed Care Plans
Jefferson
full-time
Posted on:
Location Type: Remote
Location: Remote • Pennsylvania • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- Shape the future of healthcare delivery across one of the nation’s leading academic health systems
- Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental
- 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
Requirements
- 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
- 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
Benefits
- medical (including prescription) insurance
- supplemental insurance
- dental
- vision
- life and AD&D insurance
- short- and long-term disability
- flexible spending accounts
- retirement plans
- tuition assistance
- access to tuition discounts at Thomas Jefferson University
- voluntary benefits providing colleagues with access to group rates on insurance and discounts
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization reviewmanaged caredisease managementcare managementacute carechronic carequality managementdata analysisproject managementpolicy development
Soft skills
organizational skillsinterpersonal skillstime managementcommunication skillsleadership skillsconflict resolutionindependent decision-makinginfluencing skillsnegotiation skillsanalytical skills
Certifications
Medical Physician (MD or DO)Pennsylvania Medical LicenseBoard CertificationGraduate business degree (MBA, MMM)