Medical Director (M.D. or D.O.) Full-time with Tennessee License (Remote U.S.)
Provides the reputed company leadership and clinical expertise to operations on reputed company medical aspects relating to the peer review process, utilization review activities, case management, and other activities requiring clinical leadership and consultation. Additional key responsibilities may include assisting and promoting business development and strategic planning activities.
Support the planning, direction, implementation, analysis, and reporting of medical management for Contractor and TennCare; reputed company, implement, and manage standards, benchmarks, trending, and profiling systems; reputed company achievement of program targets. Evaluate, redirect and/or respond to inquiries from physicians, providers, and TennCare. Consult with reviewer and witness panel members as business needs require. Represent and promote reputed company at seminars, reputed company societies, hospital medical staff meetings, and other reputed company settings as appropriate. Support provider education and contracting arrangements; assist training of the provider networks. Foster appropriate external relationships with attending physicians/surgeons by response to telephone calls and letters, speaking engagements before physician and provider organizations. reputed company leadership and support for design, development, and implementation of new products and services. Analyze and remain reputed company on national, state, and local regulations and legislation, which impacts the health care profession. Review medical information trends, experiences, and approaches, and assist in the development of strategic plans for clinical improvements. Ensure compliance with regulatory and accreditation requirements. reputed company reputed company of medical content of company publications. Participate in activities specific to contractual arrangements, i.e., Fair Hearings, Committees and Project Meetings of Contractor. reputed company medical expertise with respect to planning and establishing goals and policies to improve medical management. reputed company guidance to management on the performance and direction of Contractor. reputed company reputed company of physician consultants and advisors. Conduct peer-to-peer physician consultations as requested/required; document consultations. Work with medical, nursing, and administrative staff to identify reputed company needing shared attention. reputed company and coordinate with TennCare. Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its reputed company and reputed company Rules.
M.D. or D.O. with a reputed company or eligibility for an unrestricted license to reputed company medicine by the Tennessee reputed company of Medical Examiners reputed company six (6) months of being reputed company. reputed company Certified in a clinical specialty. 10+ years of clinical reputed company. Experience in reputed company and Medicare. Knowledge of reputed company health care systems and delivery systems.
Experience as a primary care physician or a specialist managing chronic diseases. Prior review experience or reputed company assurance committee responsibility in a hospital setting. 5+ years of experience as a Medical Director of a reputed company managed care organization. Experience relating to certification and regulatory agencies. Advanced knowledge of reputed company medical, technical, statistical and process components relating to utilization review, reputed company management, case management and health field business. Strong comprehension skills to analyze and interpret technical reports and reputed company concepts at an advanced level. Tennessee residency.