Chief Medical Officer | Health Plan
Job Title: Chief Medical Officer | Health Plan
Employer: MMS Group
Location: Linthicum Heights, Maryland
Job Type: Full-Time
Career Level: Experienced
Experience: 10-15 years
Education Level: Professional
Chief Medical Director For National Health Plan
If you are seeking a truly impactful career with an opportunity to improve quality of care for vulnerable populations, and do MUCH more than UR, you may wish to consider joining this health plan.
GENEROUS relocation- excellent career growth!
Executive Leader will direct and coordinate the medical management, quality improvement and credentialing functions for the Maryland market. Collaborate with health plan leadership on establishing the strategic vision for the plan.
- Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
- Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.
- Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues
- Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
- Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
- Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.
- Responsible for HEDIS improvement and strategy.
- Actively participates in the auditing process of medical management processes and corrective action team projects for medical management
- Achieves utilization, cost management and quality goals.
- Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology
- Medical Doctor or Doctor of Osteopathy
- Board certified
- Continuing part time patient care required.
- MUST HAVE previous experience working in Maryland
- Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
- Current medical license without restrictions
- Managed Care Experience – Utilization Review Experience