Medical Director
2 weeks ago
- Provides clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight of clinical team members and consultation and training with care managers in order to address cost and quality of care. Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and medical necessity decisions. Follows high risk cases throughout treatment continuum from inpatient, rehabilitation, partial hospitalization, outpatient and other levels of care. Ensures that persons with severe, complex, and/or treatment resistant illnesses receive medically necessary coordinated care throughout the episode of treatment. Continues physician oversight of at-risk patients deemed appropriate for complex case management and timely completion of all utilization management activities. Involvement in the development of case management plans.
- Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most cost-effective setting. Evaluates the effectiveness of UM practices and criteria. Actively monitors for over- and under-utilization. Assumes a leadership position relative to knowledge, implementation, training and supervision of the use of the medical necessity criteria.
- Along with the Corporate Clinical team, implements clinical practice standards and policies developed by Magellan corporate and participates in management of activities. Develops, implements and interprets medical policy, technology assessments, and medical necessity guidelines.
- Develops effective working relationships with practitioners, provider facilities, treatment programs, and may establish relationships and/or consult with client organizations. Confers directly with psychiatrists and other practitioners regarding the care of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. Identifies and immediately follows up any quality of care concerns with practitioners and provider facilities and treatment programs involved in the member's care. Ensures that contract requirements, accreditation standards (e.g. NCQA), state policies and federal policies are implemented specific to each Magellan client. Works with teams on continuous quality improvement to ensure ongoing compliance in utilization and case management.
- Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead senior medical director, and quality improvement staff. May participate in various committees or project teams as directed by the senior medical director or vice-president.
- Supports senior medical director in designing and implementing medical action plans.
- Supports senior medical director in parity analyses and documentation.
- Participates in committee work and JOC (Joint Operations Committee).
- Maintains licensure requirements for other states as assigned by senior medical director and CMO.
- Provides after hours coverage.
- May need to work beyond typical business hours to meet health plan and Magellan deliverables.
- Other duties as assigned.
Other Job Requirements
Responsibilities
Doctor of Medicine (MD) degree OR Doctor of Osteopathic Medicine (DO) degree OR Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of United States based internship and residency (and successful completion of United States based fellowship for subspecialists) required.Successful completion of the ECFMG and FLEX examinations.
Full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME).
Minimum of three years involving substantial direct patient care during this period at multiple levels of care.
Clinical experience pertinent to the patient population(s) being managed.
Unrestricted current and valid license or certification to practice medicine in a state or territory of the United States.
Ability and desire to lead through and effect appropriate changes.
Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance and continuous quality improvement (CQI) processes. (Preferred, but not required for MRx MMUM).
After Hours coverage may be required.
General Job Information
Title
Medical Director (Behavioral Health) - Texas licensed, RemoteGrade
36Work Experience - Required
ClinicalWork Experience - Preferred
Education - Required
DO, MBBS, MDEducation - Preferred
License and Certifications - Required
DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MBBS - Bachelor of Medicine, Bachelor of Surgery - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - PhysicianLicense and Certifications - Preferred
Salary Range
Salary Minimum:
$200,280Salary Maximum:
$360,500This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
-
Nurse Practitioner
2 weeks ago
Dalton, GA, United States Medical Director Services PC Full timeMedical Director Services PC - Nurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Dalton, GA. Excellent salary will be offered, commensurate with experience. New Graduates Welcome DUTIES: Assuring delivery of quality care services to all patients in a...
-
Nurse Practitioner
2 weeks ago
Roswell, GA, United States Medical Director Services PC Full timeMedical Director Services PC - Nurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Roswell, GA. Excellent salary will be offered, commensurate with experience. New Graduates Welcome DUTIES: Assuring delivery of quality care services to all patients in a...
-
Nurse Practitioner
2 weeks ago
Tucker, GA, United States Medical Director Services PC Full timeMedical Director Services PC - Nurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Tucker, GA. Excellent salary will be offered, commensurate with experience. New Graduates Welcome DUTIES: Assuring delivery of quality care services to all patients in a...
-
Nurse Practitioner
2 weeks ago
Wayne, MI, United States Medical Director Services PC Full timeMedical Director Services PC - Nurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Wayne MI. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. DUTIES: Assuring delivery of quality care services to all patients in a...
-
Nurse Practitioner
2 weeks ago
Monroe, GA, United States Medical Director Services PC Full timeMedical Director Services PC - Nurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service Park Place Nursing and Rehab in Monroe, GA. Excellent salary will be offered, commensurate with experience. New Graduates Welcome DUTIES: Assuring delivery of quality care services to all patients in a...
-
Nurse Practitioner
2 weeks ago
Sarasota, FL, United States Medical Director Services PC Full timeMedical Director Services PC - Nurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a facility in Sarasota, FL. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. DUTIES: Assuring delivery of quality care services to all patients in a respectful and...
-
Wound Care Nurse Practitioner
1 day ago
Atlanta, GA, United States Medical Director Services PC Full timeMedical Director Services PC is looking to hire a Wound Care Nurse Practitioner (NP) / Physician Assistant (PA) to service multiple skilled nursing facilities in the Atlanta, GA. Competitive salary offered commensurate with experience! Excellent opportunity for growth! Duties: Responsible for all open wounds in the facility- including cleaning and...
-
Wound Care Nurse Practitioner
2 days ago
Marietta, GA, United States Medical Director Services PC Full timeMedical Director Services PC is looking to hire a Wound Care Nurse Practitioner (NP) / Physician Assistant (PA) to service skilled nursing facilities in the Marietta, GA area. Competitive salary offered commensurate with experience! Excellent opportunity for growth! Duties: Responsible for all open wounds in the facility- including cleaning and dressing...
-
Nurse Practitioner
1 day ago
Westfield, NJ, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Westfield, NJ. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents....
-
Nurse Practitioner
24 hours ago
Lancaster, PA, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a facility in Lancaster, PA. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents. Assessing patient's...
-
Nurse Practitioner
1 day ago
Orlando, FL, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Orlando, FL. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents....
-
Nurse Practitioner
1 day ago
Williamsport, PA, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a facility in Williamsport, PA. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents. Assessing...
-
Nurse Practitioner
1 day ago
Eastchester, NY, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Eastchester, NY. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents....
-
Nurse Practitioner
1 day ago
Matawan, NJ, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a skilled nursing facility in Matawan, NJ. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents....
-
Nurse Practitioner
1 day ago
Tampa, FL, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a facility in Tampa, FL. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents. Assessing patient's...
-
Nurse Practitioner
1 day ago
Columbus, GA, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Part-Time Nurse Practitioner (NP) to service a skilled nursing facility in Columbus, GA. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Must be able to work on the Weekends Provider Duties: Serves in the role of primary care...
-
Nurse Practitioner
1 day ago
Pittsburgh, PA, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a facility in Pittsburgh, PA. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents. Assessing patient's...
-
Nurse Practitioner
1 day ago
Philadelphia, PA, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service a facility in Philadelphia, PA. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents. Assessing...
-
Nurse Practitioner
1 day ago
Ellijay, GA, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service Parkside Center for Nursing & Rehabilitation in Ellijay, GA. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term...
-
Nurse Practitioner
1 day ago
Hammonton, NJ, United States Medical Director Services PC Full timeNurse Practitioner (NP) Medical Director Services PC is looking to hire an experienced Nurse Practitioner (NP) to service our skilled nursing facility in Hammonton, NJ. New Grads Welcome!! Excellent salary will be offered, commensurate with experience. Provider Duties: Serves in the role of primary care provider to long and short term residents....