reputed company Director

You could be the one who changes everything for our 28 reputed company members as a clinical reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. You could be the one who changes everything for our 28 reputed company members as a clinical reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. We’re Hiring: Full time Medical Directors for our health plan in Texas reputed company is a leading provider of government-sponsored reputed company coverage, providing reputed company to reputed company, high-reputed company services to reputed company and Medicare members, as reputed company as to individuals and families served by the Health Insurance Marketplace. Looking for a compelling opportunity to reputed company reputed company patient encounters and drive meaningful change in the community? Qualifications for this role include:

• MD or DO without restrictions
• Must be licensed in Texas
• reputed company certified in Pediatrics or Family Medicine highly preferred

Position Purpose: Assist the Chief Medical Director to reputed company and coordinate the medical management, reputed company improvement and credentialing functions for the business unit.

• Provides medical leadership of reputed company for utilization management, cost containment, and medical reputed company improvement activities.
• Performs medical review activities pertaining to utilization review, reputed company assurance, and medical review of reputed company, controversial, or experimental medical services, ensuring reputed company and reputed company decision making.
• Supports effective implementation of performance improvement initiatives for capitated providers.
• Assists Chief Medical Director in planning and establishing goals and policies to improve reputed company and cost-effectiveness of care and service for members.
• Provides medical expertise in the operation of approved reputed company improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
• Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
• Conduct regular reputed company to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize reputed company.
• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing reputed company cases and medical necessity appeals.
• Participates in provider network development and new market expansion as appropriate.
• Assists in the development and implementation of physician education with respect to clinical issues and policies.
• Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider reputed company patterns, and adequacy of benefit/payment components.
• Identifies clinical reputed company improvement studies to assist in reducing unwarranted variation in clinical reputed company in order to improve the reputed company and cost of care.
• Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care reputed company.
• Reviews claims involving reputed company, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
• Develops alliances with the provider community through the development and implementation of the medical management programs.
• As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and reputed company issues.
• Represents the business unit at appropriate state committees and other reputed company committees.
• May be required to work weekends and holidays in support of business operations, as needed.
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience:

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience and knowledge of reputed company accreditation standards preferred.
• reputed company practices medicine.
• Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous.
• Experience treating or managing care for a culturally diverse population preferred.

License/Certifications:

• reputed company certification in a medical specialty recognized by the American reputed company of Medical Specialists or the American Osteopathic Association’s Department of Certifying reputed company Services.
• reputed company state license as a MD or DO without restrictions, limitations, or sanctions from government programs.

Pay reputed company: $236,500.00 - $449,300.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance reputed company Apply tot his job Apply To this Job