Medical Director – Managed Care Plans
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Job Description
Enterprise Medical Director at Jefferson Health leading clinical strategy and utilization management for integrated health plans. Responsible for utilization review and committee support in healthcare delivery.
Responsibilities:
- Shape the future of healthcare delivery across one of the nation’s leading academic health systems.
- Lead clinical strategy and utilization management for our integrated health plans and care management programs.
- Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental.
- Conduct peer-to-peer discussions with providers.
- Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee.
- Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services.
- Participate and/or lead rounds including but not limited to disease management, care management or admissions.
- Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs.
- Develop and or revise practice guidelines for acute and chronic care.
- Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.
- Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes.
- Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer.
- Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer.
- Perform other job duties as assigned.
Requirements:
- Medical Physician (MD or DO) required
- Pennsylvania Medical License without restriction
- Board Certification in a specialty (primary care preferred)
- Graduate business degree is a plus (MBA, MMM, etc.)
- Minimum 5 years post-residency experience in the clinical practice of medicine
- Managed care experience, with responsibility for utilization management
- Excellent organizational, interpersonal, time management and communications skills
- Strong leadership skills.
- Strong conflict resolution and independent decision-making skills
- Expert project management ability
- Strong influencing, negotiation and analytical skills
- Working knowledge of PC based applications such as Excel, Access and Word
- Knowledge of the principles of Utilization, Quality and Care Management.
Benefits:
- medical (including prescription) insurance
- supplemental insurance
- dental insurance
- vision insurance
- life and AD&D insurance
- short- and long-term disability
- flexible spending accounts
- retirement plans
- tuition assistance
- access to group rates on insurance and discounts
- tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
- access to medical (including prescription) insurance for all colleagues, including those who work less than part-time
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