Medical Director

6 days ago


Miami, Florida, United States DOCTORS HEALTHCARE PLANS, INC. Full time
Job Summary

Doctors Healthcare Plans, Inc. is seeking a highly skilled Medical Director to lead our medical division. The ideal candidate will have a strong background in managed care and experience in developing and managing utilization review and quality improvement programs.

Key Responsibilities
  • Develop and implement strategies to improve medical care management and outcomes.
  • Collaborate with quality improvement, member services, medical care management, provider relations, and the executive team to enhance quality of care and patient outcomes.
  • Review and assess complex and unique claims to ensure accurate and timely processing.
  • Provide medical expertise in planning and establishing goals and objectives to improve medical care management and outcomes.
  • Participate in provider network development and new market expansion as needed.
  • Review, assess, and negotiate provider contracts as required.
  • Interface with the provider community regarding medical care management, utilization review, and quality improvement issues and concerns.
Requirements
  • Medical degree from an accredited university.
  • Board eligible or certification in primary care.
  • Minimum of 5 years experience in managed care.
  • Experience in developing and managing utilization review and quality improvement programs.
  • Excellent leadership skills and the ability to motivate through a proactive management style.

Doctors Healthcare Plans, Inc. is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating a diverse and inclusive work environment.



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