Medical Director – Medicaid
Humana
Medical Director - Disability Evaluation Services (Remote)
SoundCloud
full-time
Posted on:
Location: Massachusetts • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- The Medical Director provides clinical leadership for the Disability Evaluation Services (DES) Program, under the supervision of the Senior Medical Director.
- As part of the DES senior leadership team, the Medical Director reviews disability regulations, directs internal clinical procedures and provides consultation to state policy makers.
- The Medical Director is responsible for supervising and/or overseeing the physician advisors and quality assurance consultants as well as ensuring compliance for contracted network consultative examination providers.
- Major Responsibilities: At the direction of the Senior Medical Director, provides clinical leadership for the disability evaluation process; Provides leadership for the disability process for Medicaid agencies and Public Employees Retirement Systems; Monitors productivity and provides oversight and clinical direction to DES clinicians, including Physician Advisors; Participates in creation of physician compensation models in conjunction with leadership team; Leads Internal Clinical Consultation Committees for MassHealth, OCA (Office of Clinical Affairs), and other Pension Retirement Contracts, for the handling and decision making of contested cases; Assists in formulating and implementing new business development strategies and marketing and sales efforts to achieve growth aligned with the strategic priorities of UMass Chan and ForHealth Consulting; Collaborates with DES clinical leadership in the interpretation of disability regulations; Participates in the review of regulation and policy changes impacting the disability evaluation process; Leads the development of clinical procedural standards and quality evaluations; Monitors and provides feedback to DES physicians and psychologists; Oversees DES quality management programs, including ongoing quality assurance, program evaluation initiatives, and performance goal management; Provides feedback to DES physicians and psychologists as well as other DES clinical staff regarding clinical policies and the outcomes of quality evaluations; Participates in the development and training for network providers and DES clinical staff, including physicians and psychologists; Advises DES staff on client issues involving sensitive medical information, adverse clinical findings, and safety issues; Directs contract compliance initiatives for DES contracted network physicians and psychologists; In conjunction with the Physician Network Manager, contributes to the recruitment and credentialing of contracted network physicians and psychologists; Provides feedback, quality assurance and disciplinary process of DES contracted network physicians and psychologists; Under the direction of the Senior Medical Director, oversees new projects and initiatives at DES for MassHealth or other clients, and explores new business opportunities for DES.
Requirements
- MD, DO or PhD prepared
- Psychologist licensed to practice
- Board certified in area of specialty
- 5 years experience in direct patient care
