Medical Director, Health Management & Quality

Maryland Physicians Care; Linthicum (MD); Presencial; USD 266.000 - 315.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision plans

100% employer Term Life Insurance

Short and Long-Term Disability

401k Employer Match up to 4%

20 days PTO

Tuition assistance/professional dev.

Descripción de la vacante

Maryland Physicians Care is seeking a Medical Director to lead and participate in its Medical Management Program. You will help develop medical policies, supervise Utilization Management, Quality Management, and Inpatient Concurrent Review, and collaborate with providers across the MPC MCO.

Qualified candidates will hold an MD or DO, be board-certified, and have extensive managed care experience, with strong knowledge of Medicaid regulatory requirements.

Formación

• MD/DO license with active status and board certification.
• Experience in managed care practices, processes, and operations.
• Knowledge of Medicaid and commercial regulatory requirements is beneficial.

Responsabilidades

• Lead and participate in Quality Management and Utilization Management processes.
• Consult with health professionals regarding concurrent review decisions.
• Provide medical direction to Pre-Authorization unit for elective requests and formulary decisions.
• Participate in grievance and appeals reviews and relevant QM/UM committees.
• Coordinate inpatient concurrent review discussions with staff and physicians.

Conocimientos

Provider standards knowledge

Interpersonal skills

MS Office

Regulatory knowledge

Educación

MD/DO license

Board certification

Managed care experience

Herramientas

Microsoft Office Suite

Descripción del empleo

Maryland Physicians Care is seeking a Medical Director to lead and participate in its Medical Management Program. You will help develop medical policies, supervise Utilization Management, Quality Management, and Inpatient Concurrent Review, and collaborate with providers across the MPC MCO.

Qualified candidates will hold an MD or DO, be board-certified, and have extensive managed care experience, with strong knowledge of Medicaid regulatory requirements.