Medical Director – Managed Care Plans
Jefferson
full-time
Posted on:
Location Type: Remote
Location: Pennsylvania • United States
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Job Level
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 & Tools
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)