• E-HealthJobs
  • $196,975.00 -196,975.00/year*
  • Westwood , NJ
  • Healthcare - Allied Health
  • Full-Time
  • 415 Old Tappan Rd

Job Title: Remote Medical Director
Category Temporary:
Industry: Healthcare
City: Fair Haven
State: VT
***The position is a very traditional MD role with a high volume of review work. *** Medical Director will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for the local market. Great opportunity for a purposeful career helping to create solutions to improve the quality and affordability of healthcare. Focus of the role is utilization management, quality management, network management and clinical coverage and policies -Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs. -Expands Health Plan's medical management programs to address member needs across the continuum of care. -Supports the Medical Management staff ensuring timely and consistent responses to members and providers. -Oversees utilization review/quality assurance, directing case management.
-Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities. -Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. -Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Qualifications: -2-3 years of experience in Health Care Delivery System either Clinical Practice or managed care. PREFER experience in an MCO BUT willing to consider local candidates (LOUISVILLE) with a keen interest in managed care. Must be an MD or DO Board Certification required - prefer Internal Medicine or Family Practice or PSYCHIATRY Active unrestricted state medical license required -any state in US- KY is a plus Prefer Medical Management/Case Management/Disease management experience of 1-3 years

Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities. -Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. -Responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Qualifications: -2-3 years of experience in Health Care Delivery System either Clinical Practice or managed care. PREFER experience in an MCO BUT willing to consider local candidates (LOUISVILLE) with a keen interest in managed care. Must be an MD or DO Board Certification required - prefer Internal Medicine or Family Practice or PSYCHIATRY Active unrestricted state medical license required -any state in US- KY is a plus Prefer Medical Management/Case Management/Disease management experience of 1-3 years


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* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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