Medical Director
The Judge Group Inc.

Location: REMOTE
Salary: $112.00 USD Hourly - $115.00 USD Hourly
Description: Our client is currently seeking a Remote Medical Director.

Please send your resume to Isabel Angelichio - iangelichio@judge.com for immediate consideration!

Location: Remote

Hours: 8:00 AM - 5:00 PM CENTRAL

Type of Engagement: Contract

This job will have the following responsibilities:

• Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values.
• Educates primary care physicians regarding systems, structures, processes and outcomes necessary for assurance of regulatory compliance related to market activities.
• Develops strategies for improving all aspects of market performance including RAPS, membership, and medical management.
• Participates in case review and medical necessity determination.
• Conducts post service reviews issued for medical necessity and benefits determination coding.
• Analyzes aggregate data and reports to primary care physician.
• Serves as the liaison between physicians and health plan Medical Directors.
• Supervises the functions of Care Coordination.
• Assesses the effectiveness of the specialty network to ensure members have access to multi specialties within their demographic area.
• Represents the providers as an influence to the credentialing committee.
• Reviews policies and procedures of credentialing department and offers guidance for revision and implementation of process.
• Educates primary care network and assists in problem resolution.
• Assists in development of medical management protocols.
• Performs analysis of utilization data and suggests/implements corrective action plans with network physicians.
• Performs all other related duties as assigned.
• Customer Service
• Oversees and insures physician compliance with UM plan.
• Evaluates performance of physicians in regards to established goals and objectives of the company.

Qualifications & Requirements:

• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree required.
• Board Certified Family Practitioner or Internal Medical Specialist required.
• Unrestricted licensed in Texas, Florida, Georgia, or New Jersey required.
• Five or more years of clinical practice experience required.
• Two or more years of experience in utilization management activities required.
• Proficiency with Microsoft Office applications required.

Preferred Education, Experience & Skills:

• Two years of experience with acute admission experience preferred.
• Two years of experience working in a managed care health plan environment preferred.
• Unrestricted license in New Mexico preferred (in addition to above).
• Bilingual (English/Spanish) fluency preferred.

Please send your resume to Isabel Angelichio - iangelichio@judge.com for immediate consideration!

Thank you, I look forward to hearing from and working with you!

Contact: iangelichio@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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