Title: Medical Director
1 month ago
Job Summary:
As Medical Director, this position is responsible for decisions related to medical care and day-to-day availability for consultation regarding services provided to the AHCCCS Managed care Acute Care, ALTCS, and special populations, as well as oversight of the care rendered to the AHCCCS population by various managed care organizations and providers.
Major duties and responsibilities include but are not limited to:
* Makes decisions related to clinical care and is available for consultation regarding care and services rendered to the ACC, ACC-RBHA, CHP, ALTCS (EPD and DDD), and other special populations. Oversight of the care rendered to AHCCCS populations by managed care organizations. Provides guidance on AHCCCS Medical Policy Manual (AMPM) and program implementation. Provides updates to the Assistant Director as well as agency leadership upon request. Reviews clinical desk level (standard work) procedures.
* Works with DHCS Clinical staff and the Deputy Assistant Director for Managed Care Clinical Compliance to improve care transition planning and procedures for members. Provide clinical leadership/insight to the Quality Management (QM) team for complex case reviews. Leads peer reviews (to be established by the QM team). Coordinates with other clinical and operational teams as clinical questions and or need for guidance is identified.
* Works closely with the Office of General Counsel Services on the clinical issues that arise in the grievance and appeals process and participates in Administrative Hearings. Supports the SMI Grievance and Appeals team with complex clinical cases related to SMI rights and related care. Assists others in the agency in implementing the Health Information Exchange (HIE), designing the best uses for these tools for the benefit of members, development of policies related to new clinical technologies, telemedicine, and HIE Initiatives.
* Conduct transplant, High Need/High Cost (HN/HC), Serious Mental Illness (SMI), Intellectually/Developmentally Disabled (DD), foster care, and other clinically complex case reviews.
* Chair Ad Hoc Health and Safety Meetings. Co-Chair AHCCCS New Technology and Services Committee. Participate in AHCCCS Medical Director Meetings. Participate in AHCCCS Pharmacy and Therapeutics Committee. Participate in AHCCCS Clinical Oversight Committee. Participate in AHCCCS Coding and Billing Review Team.
Knowledge:
* Federal regulations relating to Medicaid and Medicare
* AHCCCS rules, regulations, policies and procedures including AHCCCS medical policies & programs
* Managed care concepts and practices
* Provider community/healthcare delivery system in Arizona
* Claims and coding submission practices
* Current medical practices, procedures, pharmaceutical and devices
* Medical Quality Assurance and Utilization Review methods, practices and processes
* Credentialing standards for all medical, dental, and mid-level providers
* Principles and practices of program/project management, state budgeting, personnel management, operations analysis, and system design
* QISMC, NCQA and JCAHO standards of care
* Validation and statistical analysis of data
Skills:
* Management skills
* Excellent verbal and written communication skills
* Leadership skills
* Testify for AHCCCS in the Appeals and Grievances process as it relates to clinical issues
* Organizational skills to coordinate and keep on-target a large number of programs and projects simultaneously
* Strong computer skills
* Make clinically sound medical decisions regarding covered services for AHCCCS members
Abilities:
* Present to small and large audiences effectively
* Represent AHCCCS effectively to outside entities
* Effectively interact with AHCCCS contractors to develop a spirit of cooperation in oversight of medical care of AHCCCS members
* Multi-task in a fast-paced environment where re-prioritization occurs frequently
* Help lead and motivate a Leadership Team
* Interpret federal and state law and agency rules, regulations, policies and procedures
* Ability to work Telecommute
Minimum:
* Physician license in good standing in the State of Arizona. Board certified preferred.
Preferred:
* Five years experience in a managed care environment. Experience in Medicaid, Medicare or commercial populations. Experience with the design, development and administration of a major health care operations system. Ideal candidate will have knowledge of and experience with Indian Health Service.
* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Benefits: Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
* Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
* Other Leaves - Bereavement, civic duty, and military.
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities
By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
Learn more about the Paid Parental Leave pilot program here.
We have other current jobs related to this field that you can find below
-
Fiscal Director, Title I
3 weeks ago
Phoenix, United States State of Arizona Full timeArizona Department of Education - The Arizona Department of Education is a service organization committed to raising academic outcomes and empowering parents._ **FISCAL DIRECTOR, TITLE I** Job Location: **Title I Unit** Phoenix Location Posting Details: **Salary**: $77,000 - $82,500 Grade: 22 Closing Date: 06/23/2024 Job Summary: - This position...
-
fiscal director, title i
2 weeks ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timeJob Description:- The role of Fiscal Director for Title I, Title II, and Title IVA grants in the Academic Achievement Section is crucial for the implementation of Arizona's Every Student Succeed Act (ESSA) and other state and local initiatives.Occasional in-state and rare out-of-state travel may be required for this position.Key Responsibilities:Calculate...
-
Medical Director
2 weeks ago
Phoenix, Arizona, United States Project New Generation LLC Full timeAbout the Organization Project New Generation LLC provides individuals of all ages with disabilities the opportunity to live a life with choices, independence and dignity. We support a wide range of disabilities. Working with so many different individuals allows our staff to understand each person's life and what supports they need. This allows us to...
-
Medical Director
3 weeks ago
Phoenix, United States Sanctuary Recovery Centers Full time**Purpose**: Sanctuary Recovery Centers aspires to outline specific job functions and roles to eliminate ambiguity within the organization **Position Summary**: A medical director is responsible for monitoring and improving the level of care provided and help reduce operating costs of a healthcare facility over time. Medical directors are also responsible...
-
Medical Director
3 weeks ago
Phoenix, United States FCS, Inc. Full timeCrisis/Inpatient Medical Director Phoenix AZ MD or DO, board certification in psychiatry with an active Arizona license and DEA licensure in good standing. Minimum of 2 years experience as a physician; 3 years management experience preferred. Medical Director is responsible for establishing and overseeing psychiatric and addiction clinical practice for all...
-
Medical Director
2 weeks ago
Phoenix, United States FCS, Inc. Full timeCrisis/Inpatient Medical Director Phoenix AZ MD or DO, board certification in psychiatry with an active Arizona license and DEA licensure in good standing. Minimum of 2 years experience as a physician; 3 years management experience preferred. Medical Director is responsible for establishing and overseeing psychiatric and addiction clinical practice for all...
-
Medical Director
3 weeks ago
Phoenix, United States Southwest Network Full timePOSITION DESCRIPTIONResponsible for psychiatric services provided by Southwest Network clinical sites. Serves as a member of the executive leadership team and works collaboratively with the Chief of Clinical Operations, Chief of Quality and Compliance, Senior Directors, System of Care Director, medical staff, nursing staff, and site leaders.COMPENSATION and...
-
Medical Director
3 weeks ago
Phoenix, United States Southwest Network Full timeResponsible for psychiatric services provided by Southwest Network clinical sites. Serves as a member of the executive leadership team and works collaboratively with the Chief of Clinical Operations, Chief of Quality and Compliance, Senior Directors, System of Care Director, medical staff, nursing staff, and site leaders. **COMPENSATION and BENEFITS** -...
-
Northern Phoenix, Arizona | Medical Director
3 weeks ago
Phoenix, United States Connecticut Veterinary Medical Association Full timeNorth Phoenix Animal Clinic, a small animal hospital in greater Phoenix, is searching for a skilled veterinarian to lead our team. As our current Medical Director plans for his upcoming retirement, you will have the opportunity to lead an established clinic with a loyal client base . Dr. Wayne Lipovitch has developed North Phoenix Animal Hospital into a...
-
Medical Director
2 weeks ago
Phoenix, United States CSV NOW Full timeAbout the job: We are a leading global company based in the US, providing innovative solutions to our clients. We are currently seeking a talented, motivated and experienced Medical Director to join our team in the outsourcing/offshoring industry. As the Medical Director, you will play a critical role in overseeing the medical operations of our organization...
-
Medical Director
2 weeks ago
Phoenix, United States Csvnow Full timeAbout the job: We are a leading global company based in the US, providing innovative solutions to our clients. We are currently seeking a talented, motivated and experienced Medical Director to join our team in the outsourcing/offshoring industry. As the Medical Director, you will play a critical role in overseeing the medical operations of our organization...
-
Medical Director
3 weeks ago
Phoenix, United States CSV NOW Full timeJob DescriptionJob DescriptionAbout the job:We are a leading global company based in the US, providing innovative solutions to our clients. We are currently seeking a talented, motivated and experienced Medical Director to join our team in the outsourcing/offshoring industry. As the Medical Director, you will play a critical role in overseeing the medical...
-
Medical Director
1 month ago
Phoenix, United States CVS Pharmacy, Inc. Full timeAetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-f Medical Director, Director, Medical, Clinical, Patient Care, Health, Retail, Healthcare
-
Medical Director
2 weeks ago
Phoenix, Arizona, United States Angels Heart Inc Full timeJob DescriptionJob DescriptionWe are seeking a Medical Director to become a part of our team You will coordinate medical and health services in hospitals, clinics or similar organizations.Responsibilities:Oversee medical and health service activities and personnel Plan and coordinate health servicesWork collaboratively with physicians to implement...
-
Palliative Care, Medical Director
1 month ago
Phoenix, United States HonorHealth Full timeMedical Director Palliative Care HonorHealth Deer Valley HospitalNorthwest Phoenix 100% In-Patient Outstanding opportunity to be part of an established Palliative Care In-Patient team at a 200-bed community-based hospital with a busy Level 1 Trauma Center and Designated Primary Stroke Hospital. Being in one of the fastest growing areas of town conveniently...
-
Medical Director
1 month ago
Phoenix, United States Arizona Official Website of State of Arizona Full timeJob Summary: As Medical Director, this position is responsible for decisions related to medical care and day-to-day availability for consultation regarding services provided to the AHCCCS Managed care Acute Care, ALTCS, and special populations, as well as oversight of the care rendered to the AHCCCS population by various managed care organizations and...
-
Medical Director
1 month ago
Phoenix, United States Southwest Behavioral & Health Services Full timeSouthwest Behavioral & Health Services is seeking a seeking a Medical Director to oversee our Southwest Family Medicine program.This is a part-time position working 10 to 20 hours per week.What You Will Accomplish:Your knowledge, fundamental forward thinking, and concern for the welfare of patients and staff will be be just some of the qualities you will...
-
West Regional Medical Director
1 month ago
Phoenix, United States Monogram Health Full timePosition: West Regional Medical Director Monogram Regional Medical Directors are quality driven physicians who are dedicated to improving the well-being, quality of life, and health outcomes for our patients. We partner with the nation's leading clinical specialists to create transformative polychronic care. Monogram Health uses next generation AI...
-
Regional Director
2 weeks ago
Phoenix, United States Global Medical Response Full time**Job Description**: **Regional Director** **Remote Arizona** **Annual Compensation: $140,000 to $160,00 DOE** **This position is annual bonus eligible** **Why Choose GMR?** Global Medical Response (GMR) and its family of solutions are dedicated to delivering compassionate, quality medical care, primarily in the areas of emergency and patient relocation...
-
Medical Device
3 weeks ago
Phoenix, United States Elucent Medical, Inc. Full timeJob Title:Clinical Sales Representative Reports to:Director of SalesEDUCATION, BUSINESS EXPERIENCE AND PHYSICAL REQUIREMENTSBachelor's degree in a related field (e.g., life sciences, business, healthcare management).1-2 years of operating room and clinical medical experience preferred.80% travel required. Ability to work independently and collaboratively in...
