Health Plan Medical Director

Midland-Marvel Recruiters, LLC; Maryland; Presencial; USD 190.000 - 270.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonus incentives

Relocation

Descripción de la vacante

Midland-Marvel Recruiters, LLC is seeking a Health Plan Medical Director for a community healthcare system in Maryland. The role partners with the Executive Director to shape clinical strategy and oversee medical management programs across utilization, pharmacy, case management, and quality improvement.

Maryland EQRO and NCQA standards guide daily operations, with relocation incentives available. The position requires an MD/DO with active board certification and 5-7 years of clinical experience,

Formación

• MD or DO degree required.
• Active board certification required.
• 5-7 years clinical experience expected.
• Experience in a health plan or Medicaid managed care environment preferred.
• Supervisory/leadership experience required.
• Maryland residency or residence nearby required.

Responsabilidades

• Lead health plan clinical operations and develop clinical strategy.
• Direct medical management, utilization, pharmacy, case and quality management programs.
• Ensure compliance with Maryland EQRO standards and NCQA/HEDIS specs.
• Collaborate with system leaders, physicians, hospitals, and networks.
• Drive value-based contracting and total cost of care initiatives.
• Mentor and develop clinical staff and ensure quality improvement projects.

Conocimientos

Active Board Certification

Leadership

Supervisory experience

Educación

MD or DO Degree

Descripción del empleo

Community healthcare facility part of a system in need of Health Plan Medical Director! Bonus Incentives and Relocation!

• Looking for a Physician with senior level health plan experience!
• This position serves as a key thought partner and advisor to the Executive Director of clinical matters.
• Responsible for leadership of the health plan's clinical operations with a primary focus on developing clinical strategy and execution to drive clinical outcomes.
• Directs the development implementation and ongoing evaluation of the plan's medical management utilization management pharmacy management case management quality management and clinical improvement programs to comply with the Maryland Contract.
• Develops department goals objectives policies and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations including Maryland External Quality Review Organization (EQRO) Systems Performance Review Standards Annual Evaluation of Drug Use Management Programs and the National Committee for Quality Assurance (NCQA) for Health Plans and Case Management and HEDIS Technical Specifications according to plan needs.
• Actively participates in the development implementation and monitoring of Maryland Utilization Management Plan and Appraisal the Quality Improvement Plan and Appraisal the annual Quality Work Plan including Performance Improvement Projects HEDIS efforts and submission NCQA-related projects and others are completed.
• Collaborates on health plan quality case management and utilization of members with special health care needs to integrate medical and behavioral health services
• Reviews all denials of care for EPSDT services and Services for enrollees with Special Heath Care Needs.
• Leads and executes on innovative Managed Care disciplines to ensure optimal total cost of care management.
• Work collaboratively in developing various strategic medical expense approaches such as value based contracting strategy.
• Develops collaborative relationships with Maryland agencies and associates, system leaders, academic physicians, hospitals, community physicians, and related networks.
• Raises the visibility in the community and within the healthcare industry at large.
• Supports the mission vision and values of the organization and contributes to the achievement of the goals.

Qualifications:

• MD or DO Degree
• Active Board Certification
• 5 -7 years clinical experience
• Previous experience in a Health Plan or Medicaid Managed Care Environment
• Prior supervisory and leadership experience
• Must reside in the Maryland area
• Demonstrated commitment to ongoing clinical excellence and professional development