Senior Medical Director
Nevada

Oversees all medical care for the health plan's products and services. Oversees the health care needs of the membership and serves as the principal medical manager and policy advisor to the company and health plan CEO or COO. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Assists in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan CEO, COO, the Board and the Chief Medical Officer (CMO). Collaborates with the CMO and other health plan medical directors on national medical policies and carries out national medical policies at the health plan in collaboration with the health plan CEO or COO

Education and Experience

• Masters in Public Health, MBA or MA preferred.
• Continuing education to remain current in medical and management areas.
• Any equivalent combination of education and experience.
• Five years of clinical experience in the practice of medicine, two of which have been in medical and/or health administration.
• Three to five years of management and /or clinical experience in a managed care environment.

Certifications or Licensure
 
• Certified in a recognized medical specialty as recognized by the American Board of Medical Specialist (ABMS).
• Must be licensed in the Plan state or District of Columbia as a Doctor of Medicine or Doctor of Osteopathy.
• Active license to practice medicine issued by the State Board of Licensure or the State Board of Osteopathic Examiners.
• Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management desired but not required.