Job: clinical advisor Missouri

clinical advisor

Skills:clinical advisor       |  Location:Missouri  , United States Of America

Views:33     Premium Listing


Job description - $231,100-$325,000

Position Purpose: Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures.

•Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
•Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.
•Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues
•Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
•Facilitates the achievement of the Medical Management Program goals through an effective health services delivery system.
•Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.
•Responsible for HEDIS improvement and strategy.
•Actively participates in the auditing process of medical management processes and corrective action team projects for medical management
•Achieves utilization, cost management and quality goals.
•Participates and advises in the development of corporate medical policies for UM, pharmacy, and new technology

Qualifications:
Education/Experience:
•Medical Doctor or Doctor of Osteopathy, board certified in a specialty recognized by the American Board of Medical Specialists.
•Volunteer patient care required.
•Previous experience as Medical Director is preferred.
•Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred.
Highly Preferred:
•Experience working for a Managed Care Organization
•Medicaid
•Medicare
•Change Agent. Track record of Innovation
•Specific knowledge on HEDIS and Quality
•Ability to manage higher acuity population.


License/Certificates:
•Board Certification through American Board of Medical Specialists. Current state medical license without restrictions.

Job Level:
Corporate VP/Field CEO

More information about the job
Is Relocation Available?
Yes, nationwide
Is there a bonus structure?
20% or higher
Are you open to sponsorship?
No
Is there a possibility to work remote?
No
Is there equity?
Yes
Are there flexible work hours?
No
Does this position have direct reports?
Yes
Who does this position report to?
Plan President/CEO

What are the 3-4 non-negotiable requirements on this position?
Practicing MD, and willing to fulfill company mandatory part time practice requirements outside regular job. Experience leading a Managed Care Organization Need a "change agent" Type A.
Not afraid to speak up when there is an issue. Not someone who is solely concerned with “keeping the trains on the tracks”. Need an innovator.
Willing to speak to Provider practices and hospitals to have tough discussion when they get out of bounds. Hates waste, loves quality, and loves to educate on best practices.

What are the nice-to-have skills?
Medicaid - TANF and CHIP with a higher acuity (SSI income) population. Ability to manage higher acuity population.
Specific knowledge on HEDIS and Quality.
Strongly tied to ability to manage higher acuity population.


Job Requirements:
Practicing MD, and willing to fulfill company mandatory part time practice requirements outside regular job. Experience leading a Managed Care Organization Need a "change agent" Type A.

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