Medical Director Job at Service Care Solutions (Solihull)

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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

Medical Director

At HCSC, our employees are the cornerstone of our business and the foundation to...

Location

United States , Nashville

Salary:

191500.00 - 355600.00 USD / Year

Health Care Service Corporation

Expiration Date

Until further notice

Requirements

Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States
Maintain Board Certification by a specialty board approved by the American Board of Medical Specialties, National Board of Physicians and Surgeons, or the Advisory Board of Osteopathic Specialists
5 years of clinical experience
Analytical and communication skills
Strategic thinking skills
Proficiency in computer skills (including software applications such as Microsoft Office Product and Lotus Notes) needed for electronic documentation of case reviews

Job Responsibility

The HealthSpring Supplemental Benefits (HSB) Medical Director will work closely with HSB’s National Medical Director and HSB leadership to identify opportunities to manage and improve underwriting tools, clinical reviews and processes, deploy new innovations, and collaboratively engage clinical expertise across the Enterprise
The ideal candidate will leverage their extensive clinical experience to enable delivery of HSB’s market-leading strategies, improving the lives of the individuals we serve

Fulltime

Medical Director

We're seeking a highly experienced and strategic Medical Director to join AXA He...

Location

United Kingdom , Tunbridge Wells

Salary:

Not provided

Axa

Expiration Date

Until further notice

Requirements

Medical qualification with clinical experience and at least one postgraduate qualification or substantive experience in a similar role
Sound understanding of supporting healthcare provider management, including data and analytics
Experience providing medical leadership to improve provider and healthcare performance, including strategy, contracting, and frameworks
Demonstrable experience leading major strategic initiatives or change programs in complex environments with multiple stakeholders
Excellent analytical skills to support designing, delivering, and interpreting complex data sets
Proven track record of setting and achieving SMART goals and driving continuous improvement
Excellent communication skills, with the ability to convey technical information to non-technical audiences
Leadership experience managing multi-disciplinary teams and inspiring change across boundaries

Job Responsibility

Establish and maintain effective systems to monitor and manage the performance, quality, safety, and efficiency of our wide range of healthcare providers
Oversee the implementation of healthcare quality policies, support SME activities, and ensure provider performance is tracked, reported, and improved, setting clear clinical standards
Manage all risks related to external partnerships, ensuring compliance with legal and regulatory requirements
Provide recommendations on our clinical risk appetite and oversee medicolegal risk management for external parties
Keep a clinical risk register for the external environment, ensuring risks remain within tolerance or have action plans in place
Offer medical input to enhance provider and healthcare performance, including strategy, contracting, and frameworks
Regularly review key healthcare providers, identify areas for improvement, and ensure accountability
Lead the clinical design of sourcing and preferencing activities

Fulltime

Medical Director

Medical Director (Neurology) - United States- Remote. ICON plc is a world-leadin...

Location

United States , Raleigh

Salary:

Not provided

iconplc

Expiration Date

Until further notice

Requirements

Medical degree (MD or equivalent) with Board Certification in Neurology
Proven track record of medical leadership and consultation within CRO, pharmaceutical or biotech industries
Strong understanding of regulatory requirements and ethical standards in clinical research
Excellent communication and interpersonal skills, with the ability to represent the department effectively
Demonstrated ability to provide operational management in the absence of senior management

Job Responsibility

Providing strategic medical leadership and guidance on project teams
Offering expert medical and scientific consultation throughout project lifecycles
Ensuring compliance with ethical, legal, and regulatory standards in medical and safety monitoring activities
Representing the Medical Affairs Department in business development initiatives
Providing operational oversight within the Medical Affairs Department as needed
Up to 20% travel for meetings or conferences

What we offer

Various annual leave entitlements
A range of health insurance offerings to suit you and your family’s needs
Competitive retirement planning offerings to maximize savings and plan with confidence for the years ahead
Global Employee Assistance Programme, LifeWorks, offering 24-hour access to a global network of over 80,000 independent specialized professionals who are there to support you and your family’s well-being
Life assurance
Flexible country-specific optional benefits, including childcare vouchers, bike purchase schemes, discounted gym memberships, subsidized travel passes, health assessments, among others

Fulltime

Medical Director

Direct, lead and provide professional oversight for medical management activitie...

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 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

Job Responsibility

Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities
Provide direction, support and medical expertise and oversight to areas within the Health Services Division such including utilization management, quality management, case management, medical claims review, and pharmacy management
Provide consultative services throughout the corporation
Communicate with customers regarding their difficult and costly cases
Seek to improve department/division efficiency through effective use of information system tools
Review, and implement medical policies and other medical decision-making policies or procedures
Represent BCBSAZ at professional organizations and acts as liaison with individual health care professionals
Provide professional oversight for the various clinical peer committees
Participate in the appeals and grievance processes
Provide written information to members and providers

Fulltime

Medical Director

Arthur Lawrence is looking for a Medical Director one of our clients in Somervil...

Location

United States , Somerville

Salary:

Not provided

Arthur Lawrence

Expiration Date

Until further notice

Requirements

Experience performing utilization management determinations, appeals, and grievances in compliance with Medicare, MassHealth, NCQA, and DOI requirements
Strong background in medical necessity review, quality incident evaluation, fraud/waste/abuse support, and health plan medical policy development
Proven ability to collaborate with clinical, finance, quality, and network teams to improve care quality, control costs, and ensure regulatory compliance

Medical Director

AdventHealth Gordon is a community hospital with a 34-bed emergency department t...

Location

United States , Calhoun, Georgia

Salary:

Not provided

ApolloMD

Expiration Date

Until further notice

Requirements

Board Certified in Emergency Medicine or Primary Specialty
Documentation: EPIC

Medical Director

Medical Director needed in Cleveland! Very flexible schedule with Minimum of 2 d...

Location

United States , Cleveland

Salary:

Not provided

FCS, Inc Prince

Expiration Date

Until further notice

Requirements

Must be B.E. or B.C. with active OH license

What we offer

Highly Competitive pay and desirable benefits package

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