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Physician / Medical Director / California / Permanent / Medical Director Job

Sacramento, California
Job Type
12 Sep 2022
Administrator/Medical Director Full time Medical Director with primary care background sought for organization located in Sacramento; salaried position ($240K with robust benefit package) This is a purely administrative role with no clinic responsibilities; the work primarily involves Utilization Review and serving as a leader in UM Department. Organizations work is focuses on Medi-Cal (Medicaid equivalent in other states). Reports To: CMO This practice is affiliated with one of the largest Independent Physician Association (IPA) in Northern California uniquely dedicated to serving both the Medi-Cal and Medicare populations and serves as the bridge between Health Plans, Patients and Care Providers Benefits include: Medical, Dental and Vision Company Paid Group Life, AD&D and LTD Voluntary Life Insurance Plans Flexible Spending Plan (Medical and Dependent Care) (before-tax savings plans) Health Savings Account if enrolled in Medical High Deductible Plan Employee Assistance Plan 401K Robust PTO & Paid Holidays Plan Additional Benefits/Extra's Job Summary: Monday-Friday, currently remote opportunity The Medical Director (MD) is responsible for providing clinical expertise in support of medical management programs to promote the delivery of high quality, constituent responsive medical care. The MD is a critical medical leader and contact for external providers, plan sponsor, and regulatory agencies and participates in the strategic medical management for our plan sponsors. The medical director will partner to increase effectiveness of medical management programs and promote integration of other medical programs at the organization Primary Function Responsible for a number of activities related to the management of medical care and clinical services such as cost management, utilization review, quality assurance, and medical protocol development Oversees the activities of group physicians, including the recruiting and credentialing processes Under the direction of the Executive Medical Director, responsible for leading project management initiatives across the organization Directorship Function Attend standing meetings (board, committee, etc.) Monitor quality and appropriateness of medical care Provide guidance and leadership for performance guidelines Assist in development of policies and procedures Participate in the management of strategic development Participate in clinical peer review oversight Participate in documentation and care planning Assist in management of physician relations and/or representation Assist in adjudication of First Level Provider Appeals Support physician education Assist in management of community relations Assist in guidance for performance guidelines. Perform assigned transactional activities: Prior authorization; concurrent review; retro- active review; Meet compliance standards, contractual and legislative. Assist in care management and coordination activities Assist in staff training: Physician, Case Managers, and Staff Become proficient with company software programs. Assist in Carve Out Program management and develop proficiency with and understanding of Carve Outs (CCS, LEA, Etc.) Assist in coordination activities with contracted Health Plans and County Health Agencies Work with contracted medical providers and business partners to implement programs and resolve problems related to medical case management. Act as Medical Resource to staff Maintain professional affiliations and enhance professional growth and development to stay current in medical trends ? Competencies Knowledge of principles and practices of health planning and management sufficient to manage, direct and coordinate the operation of a major medical managed health care organization. Knowledge of purposes, organization and policies of the communitys health systems sufficient to interact with other managed care providers. Knowledge of policies and procedures of an organization sufficient to direct its operations and to provide effective patient care. Knowledge of principles and practices of employee development sufficient to ensure organizational productivity. Sacramento is one of the fastest growing cities in the nation and one of the most affordable places to live in California. The area offers a wide variety of activities to enjoy, including fine dining, shopping, biking, boating, river rafting, skiing and cultural diversity.
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  • Job Reference: 710012648-2
  • Date Posted: 12 September 2022
  • Recruiter: InSync Healthcare Recruiters
  • Location: Sacramento, California
  • Salary: On Application
  • Sector: Healthcare & Medical
  • Job Type: Permanent