Permanent Administrative Job in St. Louis, Missouri
Senior Medical Director
This job will have the following responsibilities:
- Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality, cost and outcomes.
- Direct the utilization review process and oversee the quality of utilization determinations.
- Be responsible for overall medical policies of the unit to ensure the appropriate and most cost effective medical care is received. Recommend changes and enhancements to current managed care, review guidelines, and clinical criteria .
- Develop, implement, and interpret medical polices.
- Lead clinical staff in the coordination of quality care.
- Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
- Act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
- Responsibility for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise.
- Expand their medical management programs to address member needs across the continuum of care.
Qualifications & Requirements:
- 3 to 5 + years of experience in the health care delivery system with 3-5 years additional leadership and management experience in the health care industry.
- Active unrestricted MD or DO license is required.
- Specialty in Primary Medicine or Internal Medicine preferred.
- Prior Managed Care experience
- Active unrestricted Board Certification is required. Must be board certified, not board "eligible"