HireDiversity

Description:
MEDICAL DIRECTOR Oversees the medical management programs for assigned business sector. Provides medical leadership toensure excellent quality of care and service is provided to our members/clients that is efficient and costeffective. Experience working with Medicaid required.

ESSENTIAL RESPONSIBILITIES
' Provides technical expertise in medical management by direct decision making in the areas of preauthorization;concurrent review of hospitalized patients; discharge planning; complex case and chroniccare management; and credentialing.' Oversees the clinical aspects of the quality management; credentialing; pharmacy; and medicalmanagement program.' Chairs (or staffs) all peer-review committees such as Quality Improvement; Pharmacy and Therapeutics;Credentialing; and others that are deemed appropriate for the health plan. May participate in thePhysicians Advisory Committee. Takes part in periodic consultations and/or conversations with peersand practitioners in the field.' Analyzes medical cost drivers and develops specific plans to reduce excessive cost.' Works with senior leadership to develop strategic approaches to improve company performance andexpand growth by optimizing provider network; evaluating provider (hospital; physician; ancillary)contracts; and developing other creative approaches.' Provides oversight for all quality improvement projects.' Provides oversight for all accreditation activities (URAC and/or NCQA) within the assigned businesssector.' For Medical Directors with senior clinical staff responsibilities; ensures a staff of qualified cliniciansaccountable to the organization for decisions affecting consumers is maintained; and that appeals arereviewed by non-subordinate board certified specialists.' Recruits; develops; and motivates staff. Initiates and communicates a variety of personnel actionsincluding employment; termination; performance reviews; salary reviews; and disciplinary actions.' Performs other duties as required.

JOB SPECIFICATIONS' Formal education including an MD or DO degree.' Employee must hold and maintain an active unrestricted license to practice medicine.' Board certified with post residency experience preferably in primary care specialty.' Board certification may be waived for a part-time Medical Director who will not function in the capacity ofa senior clinical staff person.' Previous (2 years) managed care experience as a Medical Director or equivalent.' Excellent clinical knowledge and skills.' Strong written and verbal communication skills.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer; and we are committed to building a talented and diverse team.

Qualifications:

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Executive/Senior Level Officials and Managers
Primary Location: Pittsburgh, PA, US
Organization: 23000 - HealthAmerica Pennsylvania Inc
Schedule: Full-time
Job Posting: 2012-07-23 00:00:00.0
Job ID: 174299k