Remote Medical Director, Utilization & Quality (HI)

VetJobs; Honolulu (HI); Teletrabalho; USD 200 000 - 300 000; Tempo integral

Resumo da oferta

VetJobs seeks a Medical Director (BH, UM) based remotely with Hawaii licensure to lead clinical operations for Medicaid/Medicare/Commercial programs. The role involves physician oversight of an interdisciplinary care management team across inpatient, partial hospitalization, and outpatient settings.

Responsibilities include developing utilization management strategies, ensuring medically necessary care, and driving clinical quality and policy adherence throughout program management.

Qualificações

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) or MBBS international degree with US internship/residency.
• ECFMG and FLEX exams completed.
• ACGME-approved US/Canada residency training.

Responsabilidades

• Provide clinical leadership to Medical Management teams and oversee care management across levels of care.
• Develop and implement Utilization Management programs and action plans.
• Lead quality improvement, credentialing, and compliance with NCQA/URAC standards.
• Collaborate with psychiatrists and practitioners to address complex patient needs.
• Support and participate in committees and performance improvement activities.

Conhecimentos

Clinical leadership

Cost-benefit analysis

Quality improvement

Credentialing

Project management

Formação académica

MD/DO/MBBS international degree

ECFMG certification

ACGME residency training

Descrição da oferta de emprego

VetJobs seeks a Medical Director (BH, UM) based remotely with Hawaii licensure to lead clinical operations for Medicaid/Medicare/Commercial programs. The role involves physician oversight of an interdisciplinary care management team across inpatient, partial hospitalization, and outpatient settings.

Responsibilities include developing utilization management strategies, ensuring medically necessary care, and driving clinical quality and policy adherence throughout program management.