Medical Director
2 weeks ago
Medical Director - Homestead, FL 33032
Compensation: $165k
Overview: Nexus HR is looking for a passionate and dedicated Medical Director who actively seeks new ways of exceeding the expectations of patients, families, caregivers, support persons, and co-workers, for a reputable medical center in Homestead, Florida.
Client-highlighted qualifications - 5 to 8 years of medical experience, with at least 2 years of medical directorship experience, a medical license in Florida, a strong foundation in primary care and geriatric care
About the Job
The Medical Director will provide medical and clinical oversight and maintain the medical management to ensure quality healthcare is provided
Duties and Responsibilities:
Monitoring the level of care using both statistical information and chart review and may offer unsolicited medical judgment when appropriate
Monitoring the use of medical services, and has the authority to issue denials of service deemed appropriate
Oversees Utilization Management Programs and may oversee Quality Improvement Programs
Oversee, implement, and constantly update utilization management policies for referrals and medications for cost-effectiveness.
Serves as a clinical resource for senior administrative management and case managers.
Assists in the development and implementation of “best practice patterns” in the form of both medical protocols and process management protocols
Participates in the review and assessment, and provides advice on complex, controversial, and/or unique claims that are outside the realm of medical policy, including solicitation and evaluation of advice from outside medical consults and physicians concerning complex, controversial, experimental and/or innovative techniques
Provides medical expertise and support to ensure appropriate care and services through a continuum between hospitals, skilled nursing facilities, and home care to ensure quality and continuity of care for complex case management
Facilitate conformance with DHS, DMHC, NCQA, and other regulatory requirements
Evaluate referral authorization requests in support of nurse reviewers and manage the denial process
Teaching and administration of charts review for Family Nurse Practitioners and Physician Assistants.
Supervises, advises and trains clinical professionals and/or students in areas of expertise.
Qualifications:
At least three (3) years of experience as a Medical Doctor
At least 10 years of experience as a medical provider
Board Certified Family Practice / Internal Medicine Physician
ACLS or CPR / AED Certified
Current medical license to practice, without restrictions, in Florida
Education, training, or experience related to NCQA, QM, multi-specialty group practice, and HMO industry
Broad knowledge base regarding managed care systems, quality improvement, medical utilization, and risk management
Must be analytical, results-oriented, able to establish priorities, and respond to requests for assistance, guidance, or decision-making on time
Preferably free from any insurance exclusivity agreement.
Experience in EMR/EHR is highly preferred
Able to work in Homestead, FL
Bilingual (English/Spanish) is highly preferred.
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