MEDICAL DIRECTOR - MOBILE, AL
Location: Mobile, AL
Our client in the healthcare industry has an immediate opportunity for a Medical Director. This is a full time, direct placement opportunity to assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit in Mobile, AL.
Our client is now one of the largest providers of Medicaid, Medicare Advantage, and other government-sponsored and commercial programs in the country. They provide access to affordable healthcare to more than 11 million members across the country.
- Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for captivated providers.
- Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies.
- Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
- Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees
Our client is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.To Apply:
- Education/Experience: Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
- The candidate must be an actively practicing physician.
- Previous experience within a managed care organization is preferred.
- Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred.
- Experience treating or managing care for a culturally diverse population preferred.
- License/Certifications: Board Certification through American Board Medical Specialties. Current state medical license without restrictions.
To be considered please immediately apply to this requisition using the link provided. For additional information please contact Betsy Vyce; [Click Here to Email Your Resumé]
; Phone #303-339-0928. Kindly forward to any other interested parties—thank you!
CTG is the most reliable IT services provider, built on 50 years of meeting our commitments to make technology work for clients and deliver real business value. CTG provides industry-specific IT strategy, services, and solutions throughout North America and Western Europe that address the business needs and staffing challenges of clients in high-growth markets, such as technology, healthcare and life sciences, financial services, industrials, and telecommunications. CTG's clients include large technology and energy companies, major health systems, and government entities.
CTG's greatest asset is our people, and as such we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work Company by Modern Healthcare (since 2013) in North America, and a Best Places to Work Company in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).
CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.