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Permanent Administrative Job in Las Vegas, Nevada

MEDICAL DIRECTOR / 100% ADMINISTRATIVE


Description

Medical Director

Overall Purpose:

The Medical Director is responsible for medical oversight of the Medical Management Program Description of organization regarding medical necessity decisions; utilization review, inclusive of prior authorization, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level.   The Medical Director support achieving the Quadruple Aim:  improved outcomes, improved patient experience, improved clinician experience and decreased cost of care. 

Education and Experience: 

  • Current, unrestricted, medical license (MD or DO)
  • Advanced degree such as MBA, MHA, MPH or MMM preferred
  • Board certified and Primary Care preferred
  • Appropriate unrestricted state medical licenses
  • Minimum 5 years practice experience
  • Minimum 2 years as a lead physician
  • Knowledge of utilization management to include experience applying medical management treatment guidelines and nationally recognized criteria, such as InterQual / McKesson, MCG, or other practical management guidelines required.  

 

Knowledge, Skills and Abilities: 

  • Strong problem-solving skills required
  • Experience in a managed care organization preferred
  • Knowledge of medical terminology required
  • Excellent communication skills with patients, providers, internal and external customers required
  • Must have excellent computer skills
  • Must have excellent organizational skills, attention to detail, and ability to work independently

 

Essential Functions: 

  • Promote the mission, vision and values of organization
  • Responsible for medical necessity decisions
  • Plans and directs medical policies
  • Responsible for strategic clinical relationships with physicians, identifying clinical trends, and directing data analysis
  • Responsible for quality and continuous improvement
  • Responsible for all actions/responsibilities as described in organizations controlled documentation for this position
  • Contributes to and supports organizations quality initiatives
  • Assist in developing in Utilization Management and Quality Management programs
  • Develops policies and procedures, guidelines, and training to ensure compliance with federal, state, NCQA, health plan, and internal regulations
  • Researches, identifies, and implements new technologies that contribute toward increased quality
  • Leadership through designated monthly meetings

Organization provides competitive salary plus guaranteed bonus incentives.  Full benefits including a $40K+ sign-on bonus also come with this great job opening.  To apply please email copy of your cv to Steven at steven.heath@pcgstaffing.com or call 972.782.4515.



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