Medical Director position responsible for Utilization Review located in Charleston, South Carolina. The position is at a Health Maintenance Organization helping those most in need,(Medicaid and Medicare) in business for 30 years, growing and practicing in 17 States that is based in Philadelphia, PA.
Some of the duties of Medical Director:
•Provide organizational leadership in the operational areas of utilization review, case management, quality improvement and related policy and practice initiatives.
•Incumbent will serve as the lead physician for the Plan working closely with other medical management team members.
•Assists in the development and implementation of medical policy, including recommendations for modifications to enhance efficiency and effectiveness.
•Assures compliance with medical policy. Maintains compliance with all federal, state and local regulatory guidelines.
•Directs the efforts of the utilization review, case management, and pre-certification functions to accomplish objectives within policy and budget.
Education/Experience: •Medical Degree (M.D. or D.O.) •2+ years of medical management and general management experience in a managed care environment is preferred. •Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred. •Utilization management experience preferred. Minimum two plus years of progressive business experience. •Must be licensed to practice in the state(s) assigned as a medical director/doctor and recognized by the proper licensing authority. •Must be Board-certified in his/her medical specialty. •Must be clear of any sanctions by the applicable state or Office of the Inspector General. •Must not be prohibited from participating in any Federally or State funded healthcare programs. •2+ years full-time experience practicing medicine •2+ years in on or a combination of the following: •Full-time experience as an administrator in a Medicare or state-level Medicaid program, Health Maintenance Organization (HMO), Preferred •Provider Organization (PPO), large Health Care Organization, Hospital or health plan or any combination thereof •Full-time medical facility administration or medical facility management
Employer will assist with relocation costs.
Additional Salary Information: 20% Annual bonus
Internal Number: 01/24/18
About Allen Thomas Associates, Inc
Allen Thomas Associates is an executive search firm providing assistance to Hospitals and health insurance organizations for over 26 years with offices in Florida and New Jersey. We specialize in Medical Directors engaged in quality assurance and utilization review.