Medical Director
4 days ago
Job Description:
As a key member of the DOCTORS HEALTHCARE PLANS, INC. team, the Medical Director will be responsible for overseeing the medical division, including medical management, case management, utilization management, and other division functions.
Responsibilities:
- Identify and analyze utilization patterns to evaluate trends in inpatient and outpatient care.
- Monitor and evaluate provider practice patterns to ensure high-quality care.
- Collaborate with quality improvement, member services, medical care management, provider relations, and the executive team to improve healthcare outcomes.
- Participate in the review and assessment of complex claims and provide medical expertise to inform decision-making.
- Develop and implement strategies to improve medical care management and outcomes.
- Interface with the provider community to address medical care management, utilization review, and quality improvement issues.
Qualifications:
- Medical degree from an accredited university.
- Board eligible or certification in primary care.
- Minimum of 5 years of experience in managed care.
- Proven track record of developing and managing utilization review and quality improvement programs.
- Excellent leadership and communication skills.
DOCTORS HEALTHCARE PLANS, INC. is an equal opportunity employer and welcomes applications from diverse candidates.
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