Associate Medical Director
One of the largest managed care organizations in the U.S. with a primary focus on the Medicare Advantage market is seeking an Associate Medical Director to join our Medical Management Department. Under the Medicare Advantage program, Medicare beneficiaries receive healthcare benefits through a managed care health plan.
In this key position as the Medical Advisor you will assist in the oversight of utilization and quality management issues for the IPA and report directly to the Chief Medical Officer. You will interact with the utilization and quality management staff and other departments of the health plan as needed. Represent the interest of the Physician Organization with any of the contracted Health Plan Organizations. The Medical Advisor assists in communications with physicians throughout the entire network.
To meet the challenges of this position you must be licensed to practice medicine in Texas and preferably board certified in his or her specialty. Have at least three (3) years of clinical experience, maintain continuing medical education standards for his/her specialty and regularly attend CME functions to enhance the management training preferred for this position.
Some of the responsibilities and functions of this position are:
Utilization Management
• Daily interaction with the utilization management staff for both outpatient and inpatient issues
• Reporting outcomes on assigned UM projects
• Medical resource to referral managers
• Round with Health Services staff on medical complex cases
• Interact with providers regarding medical care to members
• Assist in assessing the provider network for adequacy of services
• Consults with the Medical Services Manager in the development of utilization management programs.
Quality Management
• Assist in development and implementation of quality management programs within the IPA
• Acts as medical resource to the QM staff
• Participate in the credentialing activities
• Initiates and supports development of practice guidelines and protocols and disease management programs of the IPA
Provider Relations
• Provides medical liaison and representation between IPA providers, both primary care and specialists and its clinical committees.
• Interact with the provider relation staff in the credentialing process.
• Identify provider educational issues/needs to PR staff and may develop educational materials as needed by the IPA
Marketing, Finance, Planning and Policy Development responsibilities as well.