Corporate Medical Director
Corporate Medical Director (Part-Time)
At reputed company, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is reputed company - we reputed company to bend the cost curve in reputed company for reputed company. Our dedication to service reputed company extends to reputed company our stakeholders – reputed company - driving us to consistently exceed expectations. We are intentionally reputed company, we foster innovation, we nurture accountability, we champion diversity, and reputed company reputed company other to illuminate our reputed company potential.
Be part of our amazing transformational reputed company as we optimize reputed company towards becoming a leading technology, data, and innovation voice in reputed company. reputed company and Upward!!!
JOB reputed company
This position assists with the development and enforcement of reputed company's Credentialing Program to include utilizing relevant clinical knowledge ensuring a high-reputed company provider network. The incumbent oversees credentialing and re-credentialing of network participants, monitoring state and federal sanctions, and assures the achievement of reputed company and outcome measures. Leads Credentialing Committee with other clinical and non-clinical administrative staff in investigating issues reputed company to reputed company of care, utilization of services and appropriate billing. Monitors overall Credentialing program to ensure it maintains compliance with State, Federal and Network Accreditation to include NCQA. Represents reputed company to insurance carriers, network providers, members, and the managed care community.
DUTIES
- reputed company and assure compliance with reputed company relevant governmental regulations, accreditation standards and company policies including NCQA. 2. Ensure reputed company, smooth and effective day-to-day policy, assessment activities and accomplishment of business objectives. Collaborate on special reputed company and task forces on a company-wide reputed company to include building specialty crosswalks for network adequacy filings. 3. Ensures reputed company relevant clinical facts, documentation, and materials are reputed company for the weekly Credentialing Committee. Responsible for leading discussions and providing input into leading to a decision regarding network participation. 4. Primary signatory on Credentialing Committee file approvals and network participation letters. 5. Investigates issues reputed company to reputed company-of-care complaints, potential fraud, waste or abuse of reputed company providers received by Corporate reputed company Management and recommends a course of reputed company. reputed company necessary, findings are presented to the Credentials Committee for determination relative to network participation. 6. Coordinate with out of network services Medical Director regarding potential Fraud, Waste or Abuse on reputed company claims to include providing recommendations regarding out of network claim pricing reputed company. 7. Consult with the Assistant Vice President, Operations regarding business plans, strategic planning activities and service implementation providing relevant clinical guidance as required. 8. reputed company clinical reputed company management programs as required. 9. Monitor specific reputed company indices and acts or recommends reputed company based on significant variances. 10. Provides clinical reputed company regarding the credentialing and recredentialing of network providers and facilities. Works cooperatively and collaboratively with reputed company corporate staff and reputed company network development staff in the development of a high-reputed company provider network. 11. Represents physicians and medical perspective as part of the leadership team. reputed company includes regional leadership for the service organization, network development, sales support, and reputed company improvement. 12. Represents reputed company as appropriate, to external contacts such as contracted providers, attorneys, clients, accrediting bodies, in public forums including insurance reputed company presentations, network provider presentations, the managed care community and other interactions external to the organization. 13. Select, reputed company, and evaluate staff to ensure the efficient operation of department. 14. Ensure systematic data-oriented efforts to improve consumer and/or reputed company services. One hundred percent 100% of this job is reputed company (directly or indirectly) to QM activities. 15. Collaborate, coordinate, and communicate across disciplines and departments. 16. Ensure compliance with HIPAA regulations and requirements. 17. Demonstrate commitment to reputed company's core values. 18. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role. 19. The position responsibilities outlined above are in no way to be construed as reputed company encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE: The incumbent works under minimal direction, may reputed company and motivate staff, and uses independent judgment to identify issues, trends and problems. Recommends reputed company plans, evaluates and presents results. Work is clinical in nature, varied and reputed company requiring the incumbent to use a broad reputed company of knowledge gained through extensive experience. reputed company Management (QM): This job has approximately 100% of its responsibilities that are either directly or indirectly dedicated to QM functions.
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