The Medical Director works collaboratively with our internal stakeholders, providers and external customers.  This person has the opportunity to integrate medical expertise while working with representatives from all areas of the business for the purpose of managing medical benefit costs and maintaining positive customer and provider relations.

Responsibilities Include:
 
Provide clinical leadership for the utilization management process, including authorizations, denials and appeals. Offer clinical guidance to the Utilization Management nurses and other staff.
 
Respond to provider inquiries regarding utilization management decisions, complaints and appeals. Promote positive provider relationships.
 

This position is responsible for the administration of all medical services for the corporation. It is responsible for the coordination of medical policy, peer review, quality management, legal/medical issues, and the effectiveness of the Medical Management Program.
 
Responsibilities

General Summary

Responsible for clinical leadership, direction and oversight of the health plan's medical affairs including the QAPI Program as well as continuous measuring, monitoring and improvement of the health delivery system for plan members to help ensure that health plan members receive quality, medically necessary care that balances individual need with cost effectiveness. 

Essential Functions and Duties

Job Details
The Medical Director will be supporting a growing client base while combining their clinical expertise with payment policy. The MD is a key member of the Research team, as well as the client team and represents the team on all Medical Policy decisions.

The Medical Director provides oversight of a comprehensive medical policy implementation and utilization management services. The Medical Director develops and sustains an interface with member forums and facilitates the delivery of appropriate care. . The Medical Director contributes to the development of the clinical mission of the CMC, including the development, implementation, and evaluation of clinical/medical programs.

Essential Functions

Serves as Medical Director of Care Center.
Responsible for working with call center management and staff to assure high clinical quality programs are delivered to health plan members.
Candidate will lead clinical rounds to address individual patient considerations including level of intervention, provider communications and potential issues.

Chief Medical Officer
Richardson, TX

Summary

The Chief Medical Officer (CMO) provides oversight of a comprehensive medical policy implementation and utilization management services. The CMO develops and sustains an interface with member forums and facilitates the delivery of appropriate care. The CMO contributes to the development of the clinical mission of the Service Center, including the development, implementation, and evaluation of clinical/medical programs.

Rapidly expanding Medicare HMO in Tampa, Florida is searching for a Senior Medical Director.