Medical Director, New Century Health Plan
1 week ago
Job Summary:
We are seeking a dedicated and experienced clinical leader to join our team at MedChi, The Maryland State Medical Society. As a Medical Director, you will play a pivotal role in leading clinical efforts to optimize care delivery and outcomes for our members.
Key Responsibilities:
- Provide Clinical Leadership: Ensure the highest standards of care and cost-effectiveness through clinical oversight and leadership.
- Manage Utilization and Case Management: Drive efficiency and quality by managing utilization and case management activities.
- Oversee Appeals and Grievances: Manage appeals, grievances, and potential quality issues (PQI) to ensure compliance with regulatory requirements.
- Develop Clinical Strategies: Develop and implement clinical strategies to improve health outcomes and ensure compliance with regulatory requirements.
- Collaborate with Senior Leaders: Enhance the overall performance of our Medicare Advantage Plan by collaborating with senior leaders.
Qualifications:
- MD or DO Degree: Possess a degree from an accredited medical school.
- Board Certification: Hold board certification in a primary care specialty (Internal Medicine, Family Medicine, Geriatrics).
- Valid Medical License: Possess a valid and unrestricted medical license in California.
- Advanced Degree: Possess an advanced degree in healthcare management or a related field (highly desired).
- Clinical Experience: Possess 3 or more years of clinical practice experience.
- Medicare Advantage Experience: Possess 2 or more years of Medicare Advantage management experience.
- Healthcare Experience: Possess experience in a health plan or large healthcare organization (preferred).
- Regulatory Knowledge: Possess strong knowledge of Medicare regulations and CMS guidelines.
- Analytical and Communication Skills: Possess excellent analytical, problem-solving, and decision-making skills, as well as strong communication and interpersonal abilities.
- Leadership Abilities: Demonstrate proven leadership abilities that demonstrate openness to change and a capacity for implementing creative programs that support strategic initiatives.
- Technical Skills: Possess strong analytical, organizational, and project management skills, as well as proficiency in Microsoft Office applications (Word, Excel, PowerPoint).
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