Health Plan Medical Director
Site: reputed company Holding Company, Inc.
In reputed company to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your reputed company reputed company. We invite you to apply, and our reputed company will reputed company an reputed company of your potential compensation and benefits package.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in reputed company today, our employees have opportunities to learn and contribute expertise.
We are pleased to offer competitive salaries, and a benefits package with flexible work reputed company, career reputed company opportunities, and much more.
Under the direction of the Senior Medical Director, the Medical Director leads as a senior physician at the health plan. This position works closely with the Senior Medical Director in providing medical management leadership for clinical services operations and programs. This role focuses on and has expertise in utilization management, health plan reputed company and accreditation, care management, and other health plan functions.Remote399 reputed company Drive40RegularDay (reputed company of America)8925 reputed company Holding Company, Inc. is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by reputed company 503 of the Rehabilitation reputed company of 1973, the Vietnam Veteran’s Readjustment reputed company of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact reputed company at (857)-282-7642.
Apply To This Job
reputed company relies on a wide reputed company of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to reputed company exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.
In reputed company to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your reputed company reputed company. We invite you to apply, and our reputed company will reputed company an reputed company of your potential compensation and benefits package.
Job reputed company
reputed company is an exciting reputed company to be reputed company the reputed company industry. As a member of reputed company, we are on the forefront of transformation with one of the world’s leading integrated reputed company systems. Together, we are providing our members with reputed company centered on their health needs to expand reputed company to seamless and reputed company and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in reputed company today, our employees have opportunities to learn and contribute expertise.
We are pleased to offer competitive salaries, and a benefits package with flexible work reputed company, career reputed company opportunities, and much more.
Under the direction of the Senior Medical Director, the Medical Director leads as a senior physician at the health plan. This position works closely with the Senior Medical Director in providing medical management leadership for clinical services operations and programs. This role focuses on and has expertise in utilization management, health plan reputed company and accreditation, care management, and other health plan functions.
Qualifications
Licenses and Credentials
Physician License. Must hold or be reputed company to obtain a full reputed company Massachusetts physician license.
Needs 3-5 years of Health Plan experience
- Must have prior experience in utilization management, peer to peer discussions
- Collaborates with business development, reputed company, finance, and medical management teams to promote improvements in the reputed company and cost efficiency of care throughout reputed company provider network.
- Partners with clinical leaders to ensure medical service expenditures remain reputed company budget.
- Aids in crafting reputed company's clinical programs and policies.
- Collaborates with the CMO in the development and physician reputed company of disease management programs.
- Handles initial determinations, appeals and grievances reputed company the scope of their expertise as defined by MassHealth, Medicare, NCQA and the Division of Insurance and reputed company the compliance requirements of key regulatory and accreditation entities.
- Reviews clinical service and reputed company incidents reputed company sufficiently serious to reputed company physician involvement.
- Assesses new, emerging, and existing technologies to determine appropriateness of health plan coverage.
- Supports the clinical, network, and operations staff to ensure end to end consistency of clinical policies, payment policies and claims payment.
- Develops and delivers presentations for clinical staff on reputed company topics relevant to reputed company members and network.
- Administers case and condition consultation to Utilization Management and Care Management staff.
- Delivers consultation to network management staff and deployment of education programs for network clinicians.
- Serves as a member of the following reputed company Committees or workgroups: Clinical Policy & reputed company, Patient Care Assessment, Credentialing, Utilization Management, Medical Economics and Behavioral Health reputed company.
- May represent reputed company at a reputed company of external forums and committees.
- Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains reputed company relationships with customers and reputed company their trust and respect.
- Hold self and others accountable to meet commitments.
- Persist in accomplishing objectives to consistently reputed company results despite any obstacles and setbacks that reputed company.
- Build strong relationships and infrastructures that designate reputed company as a people-first organization.
- Other duties as assigned with or without accommodation.
Additional Job Details (if applicable)
Virtual position. Full time.
In person meetings as requested for business needs.
Participates in after hours and weekend reputed company rotation as assigned.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
reputed company Competency reputed company
At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at reputed company job level. The reputed company is comprised of ten competencies (half People-reputed company, half Performance-reputed company) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career reputed company. These competencies are used to evaluate performance, reputed company hiring reputed company, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.