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Job Summary
MetroPlusHealth is seeking a highly skilled Medical Director to join our team. As a key member of our leadership team, the Medical Director will play a critical role in ensuring the delivery of high-quality, cost-effective healthcare services to our members.
Key Responsibilities
- Develop and implement clinical policies and procedures to ensure appropriate healthcare utilization management.
- Collaborate with our Chief Medical Officer to develop and implement strategies to improve healthcare outcomes and reduce costs.
- Conduct peer-to-peer discussions with physicians and other healthcare professionals to educate them on current policies and medical management issues.
- Assist in the development and implementation of new technologies and clinical policies to improve healthcare outcomes.
- Perform medical necessity and appeal reviews to ensure compliance with regulatory requirements.
- Supervise retrospective reviews of claims to identify areas for improvement and reduce costs.
- Conduct analyses to identify trends and patterns suggestive of inappropriate or excessive use of services or equipment.
- Participate in department committees to ensure alignment with organizational goals and objectives.
Requirements
- Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine.
- A minimum of three years' clinical experience.
- A minimum of two years' experience in a managed care setting, particularly in utilization management.
- Valid and current license to practice medicine in the state of New York.
- Board Eligible/Certification.
Preferred Qualifications
- Experience in a leadership role, preferably in a healthcare organization.
- Strong analytical and problem-solving skills.
- Excellent communication and interpersonal skills.
- Ability to work in a fast-paced environment and prioritize multiple tasks and projects.
