Medical Director part time

Job title: Medical Director temporary

Location:Remote EST preferred

Part Time Position

Summary of Job:

Manage the daily clinical operation and administration of a Medical Management Department or function to supportimproved utilization results across the spectrum of medical specialties. Provide clinical leadership both internally and externally. Serve as an essential liaison among Senior Management Plan staff contracted providers vendors and membership to promote and improve communication and operations areas of medicine including Internal Medicine OB/GYN Psychiatry Ambulatory Medicine Emergency Medicine and Radiology. Carry out assigned programs to assure the delivery of quality medical care to the companys membership ensuring compliance with contractual obligations and standards and assisting in the development and implementation of new policy and programs as needed. Ensure operational effectiveness and oversight of assigned functions assuring regulatory compliance and accreditation with Department of Health Department of Insurance CMS NCQA and URAC standards.

Responsibilities:

• Manage use of medical resources for inpatient and outpatient services including Internal Medicine OBGYN Neurology Surgery Pediatrics Emergency Medicine or Psychiatry.
• Determine medical appropriateness through the application of clinical criteria; perform case management review; and participate in the clinical appeals process.
• Sole authority and responsibility for issuing clinical adverse determinations based on medical necessity.
• Conduct medical rounds attend Medical Director meetings and participate in the interrater reliability process.
• May also perform peer clinical reviews as needed.
• Establish and maintain continuity in the planning development and implementation of policies operational processes workflows required to execute organizational strategies and to assure consistency in process applicationthroughout Care Management.
• Validate and monitor adherence to implemented policies procedures workflows and processes: identify recommend and implement improvement initiatives accordingly.
• Generate methods to develop and improve the overall delivery and performance of the department.
• Implement process improvements in a timely manner.
• Deal effectively with and lead others throughout Company structure.
• Support other areas in implementing crossdepartmental changes.
• Make sound decisions based on all available data.
• Determine medical appropriateness through the application of clinical criteria and perform case management review.
• Demonstrate familiarity with highrisk populations community settings and care of medical patients.
• Anticipate and identify key source information to analyze problems clearly and determines creative solutions.
• Provide thought leadership to articulate and help build an effective and efficient medical delivery program.
• Identify trends problems and opportunities conduct root cause analysis.
• Implement action plans in an effective and efficient manner aimed at promoting goals/resolving barrier issues.
• Strive to improve efficiencies of key operational areas.
• Assist with contract negotiations as necessary.
• Represent Care Management in interdepartmental committees designed to meet organizational goals.
• Develop annual goals and oversight of assigned department/function.
• Support Senior Medical Directors in communications with internal and external organizational goals; ensure a high level of customer satisfaction (members vendors providers regulators accreditation agencies peers and employees).
• Chair or participate on committees as requested.
• Regular attendance is an essential function of the job.
• Perform other duties as assigned or required.

Qualifications:

• MD or DO degree. Board certification is required
• Active New York license or certification to practice medicine without restriction required
• 10 years of relevant professional work experience
• 5 years of clinical practice
• Administrative experience on a hospital committee in a medical group or for an insurer
• Knowledge of clinical practice of medicine health care delivery systems utilization methods and treatment protocols
• Knowledge and understanding of managed care principles industry evolution physician reimbursement and human resource management
• Experience conducting evidencebased treatments in group and individual modalities especially for psychiatric treatment
• Considerable independent decision making with physicians members subordinates other departmental leaders and external vendors regulatory and accreditation agencies
• Communication skills both oral and written tact and diplomacy sufficient to successfully carry out the above duties and responsibilities

The pay for this role is $150.00 an hour paid every Friday.

Benefits throughCGC:Payday Fridays Dental Vision STD and/or LTD Voluntary Life & AD&D Accident Critical Illness Hospital Indemnity Health Advocate EAP and Health Equity Commuter Benefits ZayZoon and 401k.

We are anequalopportunityemployer and prohibit discrimination/harassment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws