Director Medical Staff Services Job at Summerlin Hospital Medical Center (Henderson)

Director - Medical Staff Services

The Valley Health System (VHS), with seven hospitals in Las Vegas and Southern N...

Location

United States , Las Vegas

Salary:

85314.00 - 113041.00 USD / Year

Summerlin Hospital Medical Center

Expiration Date

Until further notice

Requirements

Bachelor’s degree in related field preferred or equivalent combination of education and experience
Two to three years experience in leadership/management position in Medical Staff and/or Performance Improvement
Computer proficiency to include word processing, spreadsheet, database, and internet
Certification as appropriate for the position (ex. Certification by healthcare certification board or National Association of Medical Staff Services or equivalent certification)
Professional in medical staff services and/or quality management preferred
Demonstrates strong skills and knowledge in credentialing standards and principles
Demonstrates strong analytical and organizational skills
Effective written and oral communication skills

Job Responsibility

Responsible for directing, planning, organizing, controlling and coordinating all administrative, financial, educational and managerial activities of the Medical Staff Department and the Medical Staff Foundation for Education

What we offer

Challenging and rewarding work environment
Competitive Compensation & Generous Paid Time Off
Excellent Medical, Dental, Vision and Prescription Drug Plans
401(K) with company match and discounted stock plan
SoFi Student Loan Refinancing Program
Career development opportunities within UHS and its 300+ Subsidiaries

Fulltime

Medical Director, Behavioral Health - SIU

We're building a world of health around every individual — shaping a more connec...

Location

United States , Work at Home

Salary:

174070.00 - 374920.00 USD / Year

CVS Health

Expiration Date

June 26, 2026

Requirements

Five (5) or more years of experience in a healthcare delivery system (e.g., clinical practice)
Board Certified Psychiatrist not 'Board Eligible' - Active and Unencumbered license to practice medicine
Knowledge of pertinent policies and procedures related to claims payment of healthcare related services
Active and current state medical license(s) without encumbrances - M.D. or D.O., Board Certification in psychiatry, including 5 years of post-graduate direct patient care experience

Job Responsibility

Performing reviews of BH medical records and/or CPT code/HCPCS codes of known or suspected acts of healthcare fraud and abuse
Serves as a clinical liaison supporting SIU Investigators, Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases
Provides clinical expertise and consultation in the creation of data analytic monitors to identify potential patterns of suspected fraud, waste or abuse
Provides consultation to staff regarding root cause analysis and identification of control gaps in Policies, Procedures, Claims edits etc., and assists in seeking appropriate departments to identify solutions
Provides clinical expertise to internal and customers regarding healthcare fraud matters and Aetna's approach to fighting fraud
Maintains open communication with constituents within the company
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse
Researches and prepares cases for clinical and legal review
Documents all appropriate information related to medical record review determinations
Represents Aetna as a witness in court actions, as required, and as approved by Legal

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
CVS Health bonus, commission or short-term incentive program
Equity award program award target

Fulltime

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Medical Director, Health & Counseling Center

The University of Denver seeks a student-centered physician leader to serve as t...

Location

United States , Denver

Salary:

225000.00 - 250000.00 USD / Year

The University Of Denver

Expiration Date

Until further notice

Requirements

MD or DO degree from an accredited institution
Current unrestricted license to practice medicine in Colorado, or eligibility for Colorado licensure by the start of employment, full prescriptive authority, NPI number
Board certification in family medicine, internal medicine, or another specialty relevant to college health
DEA registration and other credentials required for clinical practice and prescribing, as applicable
Required 7 years’ experience in a primary care setting after residency with at least 3 years leading clinical and/or administrative operations such as quality improvement, patient safety initiatives, and supervising staff
Current BLS/ACLS
Eligible to obtain adequate professional liability insurance coverage

Job Responsibility

Provides direct outpatient medical care to University of Denver students through scheduled visits, same-day access, follow-up appointments, and other clinical services consistent with the scope of HCC medical practice
Delivers student-centered, evidence-based, developmentally and trauma-informed care to a diverse student population, with attention to access, continuity, prevention, and health education
Participates in clinical coverage, consultation, documentation, care coordination, and referral management to support safe, timely, and effective student care
Collaborates closely with counseling, psychiatry, health promotion, and Student Affairs partners to support students whose needs intersect across physical health, mental health, and campus functioning
Models clinical excellence, professionalism, and a strong commitment to equity, confidentiality, and service in the delivery of care
Serves as the supervising/collaborating physician of record for advanced practice providers within the HCC
Provides strategic and clinical leadership for medical services within the Health & Counseling Center, including primary care and related outpatient services
Ensures high-quality, student-centered, accessible, and clinically appropriate medical care for DU students
Oversees clinical standards, scope of practice, documentation expectations, protocols, and quality improvement processes for medical services in service of ongoing AAAHC certification
Partners with clinical and administrative leaders to optimize access, continuity, scheduling, triage, patient flow, and the overall student experience of care

What we offer

Fringe benefits (including malpractice insurance, license fees, workers' compensation, and DEA renewal)

Fulltime

Medical Director

Medical Director (Part-Time) Care Management California, United States Because...

Location

United States , California

Salary:

91.00 - 114.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

MD or DO degree and 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment
Current and ongoing Board Certification in an approved ABMS Medical Specialty
A current and unrestricted license in the state of California and willing to obtain additional license(s), if needed. (Optional)
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements
Minimum 5 years of Utilization Review or Hospital experience required
Minimum 3 years of compliance related experience preferred
Managed Care experience preferred in utilization review and case management
Basic computer literacy
The ability to work on multiple screens, and proficient typing skills
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook

Job Responsibility

The Medical Director relies on their medical background to review claims for medical necessity for prior authorization, continued stay review and post service
The Medical Director can read, interpret, and apply medical policy, guidelines, and research to utilization review
The Medical Director has authority for issuing adverse determinations while performing medical necessity evaluation
Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances, these may require conflict resolution skills
Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope
Keep the team informed of clinical updates through educational opportunities by developing educational materials for staff
Work with the VP of Care management to establish work procedures and processes that support company and departmental standards, procedures, and strategic directives
Excellent verbal and written communication skills
Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation)
Knowledge of the managed care industry as it relates to commercial business

What we offer

Part-time schedule designed around your availability and life priorities
Access to learning and development opportunities alongside full-time colleagues
Mentorship and skill-building that translates to career advancement
Competitive hourly compensation that values your expertise
Technology and equipment support to set you up for success

Parttime

Associate Medical Director of Lung Transplantation

The Division of Pulmonary and Critical Care Medicine at Mass General Brigham/Mas...

Location

United States of America , Boston

Salary:

Not provided

American Society of Transplantation

Expiration Date

Until further notice

Requirements

M.D. or equivalent
experience in all areas of pulmonary and critical care medicine with a particular focus and experience in lung transplantation

Job Responsibility

Play a leadership role in the growth and development of the lung transplant program
major clinical responsibilities for both the inpatient and outpatient Lung Transplant Services at MGH
engage in teaching students, house staff, and fellows in the clinic and inpatient settings

Fulltime

Medical Director Veterinarian

At PetVet Care Centers, our mission is to improve the lives of animals and peopl...

Location

United States , Grass Valley

Salary:

170000.00 - 190000.00 USD / Year

Grass Valley Veterinary Hospital

Expiration Date

Until further notice

Requirements

Veterinarian degree (DVM) from an accredited college or university
Current State Veterinary License
DEA registration must be obtained and maintained
3-5+ years of experience in a veterinary practice
Strong diagnostic and clinical skills
Excellent surgical and dental skills
Ability to work well in a team-oriented environment
Exceptional interpersonal and communication skills
Commitment to providing compassionate and high-quality veterinary care
Excellent Communication Skills and the ability to communicate effectively, efficiently, and in a timely manner with all members of the Medical and Hospital staff

Job Responsibility

Maintaining a high quality of progressive veterinary care
Oversees and gives directives regarding medical standards and quality of care
Sets policies as they pertain to the practice of medicine
Works toward making various services work as one team
In conjunction with appropriate leadership team members, recommends additions to the hospital inventory
Budgets for new equipment and provides a reasonable cost estimate and return on investment
Sees patients and handles clinical practice
Ensures positive communication with clients and between doctors, including the proper transfer of patient care responsibilities
Reviews patient records for completeness and accuracy and uses them to promote medical excellence
Appropriately manages controlled drugs

What we offer

Medical Director stipend
No negative accrual and no non-compete
Paid time off and holidays
Generous sign-on bonus
Relocation assistance
Flexible schedule options
Signing, retention and relocation packages up to $75,000
Medical, dental, and vision insurance
Paid Parental Leave (birth, adoption, foster)
401(k) with discretionary contribution

Fulltime

Medical Director of Case Management and Utilization Review

The Medical Director of Case Management and Utilization Review leads the hospita...

Location

United States , Miramar

Salary:

Not provided

Memorial Healthcare System

Expiration Date

Until further notice

Requirements

Medical Doctor (Required)
Medical Doctor License (ME LICENSE) - State of Florida (FL)
Osteopathic Physician License (OS LICENSE) - State of Florida (FL)
Extensive experience in one or more branches of medicine or surgery
at least, five (5) post-training years of medical staff organization/administrative experience in a large acute care hospital
Graduate of a medical school approved by the Council on Medical Education of the American Medical Association
Excellent customer service and interpersonal skills
Able to effectively present information, both formal and informal
Strong written and verbal communications skills with all levels of internal and external customers
Strong analytical skills

Job Responsibility

Supports education and clinical documentation improvement
Leads Complex Care Management
Leads hospital initiatives to reduce complex patient length of stay
Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay
Provides peer review services for medical necessity of admission or continued stay
Supports the Senior Medical Director in Medical Staff Education
Assists physicians in improving the quality of their medical necessity documentation
Serves as liaison to insurance companies for prior authorizations and removes barriers to discharge
Supports case management by attending interdisciplinary rounds (IDR) and provides feedback and suggestions to physicians and CMs
Serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff

Fulltime

Behavioral Health Medical Director

The Behavioral Health Medical Administrator (Medical Director) directs, leads, a...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

3 years of experience in a clinical setting
1 year of experience in physician leadership role, including quality review, utilization review, population health and other managed care functions
Medical Degree
Active, current, and unrestricted license to practice medicine in the State of Arizona (a state in the United States)
Board Certification in general psychiatry, or adult and child/adolescent psychiatry, through the American Board of Psychiatry and Neurology
Requires knowledge and skills in state (Arizona) and federal behavioral health regulations, requirements for publicly funded services, delivery, operations, and licensure.
Knowledge of managed care concepts and practices
and emerging and best practices for adult & children’s integrated care programs.
Ability to use electronic word processing, email, and electronic database resources.
Excellent customer service and oral/written communication skills

Job Responsibility

Directs, leads, and provides professional oversight for medical management and population health activities related to behavioral health utilization management, case and care management, disease management, performance improvement, and quality management activities.
Supports collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals in compliance with AHCCCS and CMS regulations.
Provides physician leadership and medical oversight in the design, implementation and review of clinical services, best practices, care management, medical management and quality management.
Serves as liaison between the Medicaid Business Segment and medical and behavioral health practitioners at stakeholder and provider agencies.
Participates in aggregate and member-level clinical analyses for quality management, quality of care concerns, peer review, medical management, and utilization review processes.
Reviews and authorizes requests by providers and treatment coordinators for services or programs requiring prior authorization.
Participates in the design and implementation of best practices, clinical standards, protocols, and treatment guidelines.
Participates in credentialing, re-credentialing and competency processes for providers.
Assists care managers with care management of high risk/high-cost members.
Participates as a member or chair of internal and external committees.

Parttime

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Director Medical Staff Services

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