This position is responsible for the administration of all medical services for the corporation. It is responsible for the coordination of medical policy, peer review, quality management, legal/medical issues, and the effectiveness of the Medical Management Program. Responsibilities
Oversee the Health Services Department to include Medical Management, Quality Management and Pharmacy Programs Responsible for the administration of medical services including utilization and quality of care issues. Responsible for the development and implementation of clinical criteria based upon previous experience, utilization and reimbursement methods and treatment protocols. Provide medical expertise in the evaluation of reimbursement methodology, fee review, claims payment. Provide support and resources to assist the provider network to serve health plan members in an effective manner and foster a climate of cooperation and communication among the leadership of the provider networks. Responsible for recommending changes and enhancements to managed care plans and services offered. Participate in corporate strategic planning. Assist in provider recruitment and retention. Perform annual performance review for direct reports. Conducts positive counseling as is necessary and maintains written documentation. Reports directly to the Chief Executive Officer relative to the design and implementation of managed care plans for specific patient populations. Position may have other physicians reporting directly to them. Supervisory Responsibilities
Responsible for the supervision of the Health Services Department and Associate or Assistant Medical Directors and/or Physician Consultants. Job Related Skills
Significant experience in health care management. Broad knowledge of managed care concepts. Excellent analytical, organizational and decision making skills. Strong leadership, negotiation and communication skills. Exceptional presentation skills. Strong clinical information systems skills. Ability to communicate well with all levels of medical personnel, all types of providers and the insurance brokerage community.
