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DO / Administration Job in Sacramento, California / Permanent

Company: Murdock Consulting
Location: Roseville
Posted on: April 17, 2018

Job Description:

Physician / Medical Director: Utilization Review / Sacramento, CA


Medical Director Needed in Sacramento, California.

100% administrative doing Utilization Review in Medical Management Department.

Must be an MD or a DO
Willing to consider a provider in any medical or surgical specialty.
Must have past experience with Utilization Review.
In order to be successful, they would need to have familiarity with transactional activities such as Prior authorization; concurrent review; retro-active review; claim review.


The Medical Director (MD) is responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent responsive medical care.

The MD is a critical medical and business leader and contact for external providers, plan sponsor, and regulatory agencies and participates in the strategic medical management for our plan sponsors. The medical director will partner with UM to increase effectiveness of medical management programs and promote integration of other medical programs at Medical Group.



Main functions of a medical director:

Holds a senior medical administrative position in a medical group independent practice association.
Responsible for a number of activities related to the management of medical care and clinical services such as cost management, utilization review, quality assurance, and medical protocol development.
Oversees the activities of group physicians, including the recruiting and credentialing processes.


Directorship duties and responsibilities:

Attend standing meetings (board, committee, etc.)
Monitor quality and appropriateness of medical care
Provide guidance and leadership for performance guidelines
Assist in development of policies and procedures
Participate in the management of strategic development
Participate in clinical peer review oversight
Participate in documentation and care planning
Assist in management of physician relations and/or representation
Assist in adjudication of First Level Provider Appeals
Address emergency issues
Support physician education
Assist in management of community relations
Assist in guidance for performance guidelines
Perform assigned transactional activities: Prior authorization; concurrent review; retro- active review; claim review
Provides physician oversight of medical care management and utilization review in all RCMG offices. Provides clinical guidance in complex medical decision processes
Meet compliance standards, contractual and legislative
Assist in care management and coordination activities
Assist in staff training: Physician, Case Managers, and UM Staff
Become proficient with company software programs
Assist in Carve Out Program management and develop proficiency with and understanding of Carve Outs (CCS, LEA, Etc.)
Assist in coordination activities with contracted Health Plans and County Health Agencies
Work with contracted medical providers and business partners to implement programs and resolve problems related to medical case management
Act as Medical Resource to medical group staff
Maintain professional affiliations and enhance professional growth and development to stay current in medical trends
Adhere to company policies and procedures, guidelines, and directives.
Maintain strict operating and patient confidentialityContributes to a healthy, positive and safe environment and promotes self as a team member


Knowledge, Skills & Abilities:

Knowledge of: principles and practices of health planning and management sufficient to manage, direct and coordinate the operation of a major medical managed health care organization; purposes, organization and policies of the community s health systems sufficient to interact with other managed care providers; policies and procedures of an organization sufficient to direct its operations and to provide effective patient care; principles and practices of employee development sufficient to ensure organizational productivity.

Skill in: exercising a high degree of initiative, judgment, discretion and decision-making to achieve organizational objectives and in developing, applying, interpreting and coordinating policies and procedures; analyzing situations accurately and taking effective action; negotiation; organizing work, making assignments and achieving goals and objectives.

Ability to: assume responsibility and exercise authority over assigned work; establish and maintain quality control standards; organize and integrate organizational priorities and deadlines; prepare comprehensive reports.


Community:

Sacramento, California.

Keywords: Murdock Consulting, Sacramento, DO / Administration Job in Sacramento, California / Permanent, Healthcare, Roseville, California

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