PhiladelphiaRecruiter Since 2001
the smart solution for Philadelphia jobs

MEDICARE MEDICAL DIRECTOR

Company: The French Group
Location: Philadelphia
Posted on: February 25, 2021

Job Description:

Home / Medicare Medical Director - Philadelphia, Pennsylvania Medicare Medical Director - Philadelphia, Pennsylvania The French Group has been retained by our client, an award-winning not-for-profit health plan, to identify a Medicare Medical Director. Job Summary The Medical Director will function as an integral part of the Health Care Senior Management team with responsibility for care management, quality management and pharmacy services programs. This position will focus on Medicare and Medicare Advantage, but may also be involved with other product lines and services which have attracted seniors or disabled individuals. This position will represent Health Care Management in interdepartmental activities and represent the Plan in the health system and provider communities as well as in regulatory and governmental activities. The Medical Director will apply clinical expertise and experience as a provider to promote the appropriate delivery of medically necessary services to the population served. She/he will perform utilization, pharmacy and quality reviews and will analyze and profile utilization patterns in order to meet with and direct network providers. The Medical Director will also be very familiar with Medicare regulations and provide expertise and support to the Stars program and accurate acuity scoring efforts. Primary Responsibilities

  • Provide utilization management services and advise the Health Care Senior Management team regarding the utilization of health care services and interventions, disease management and case management services to promote the effective delivery of medically necessary services.
  • Serve on and support the functions of the Utilization Management Committee, Credentialing Committee, Pharmacy & Therapeutics Committee, and the Quality Management Committee.
  • Serve as a resource to the Finance Department in evaluating present utilization experience and projecting future utilization patterns.
  • Provide leadership for Plan accreditation processes (NCQA), Stars, Utilization, Quality and Disease Management programs.
  • Develop and or revise practice guidelines for acute and chronic care.
  • Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.
  • Collaborate with Health Care Economics and Finance to continuously improve the collection and use of data describing resource utilization, outcomes and acuity scoring.
  • Represent Health Care Management internally and externally at the direction of the Chief Clinical Officer.
  • Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the Chief Clinical Officer. Requirements
    • MD or DO with active, unrestricted Pennsylvania medical license plus MBA/MPH desirable
    • Current board certification in ABMS recognized specialty; primary care preferred
    • Minimum 5 years post-residency experience in the clinical practice of medicine, preferably with management responsibility.
    • Minimum 3 years of experience in a managed care setting, preferably with responsibility for utilization management.
    • Strong familiarity with Medicare, Medicare Advantage, utilization analytics and management as well as familiarity with federal regulations relating to utilization management activities is required.
    • Excellent organizational, interpersonal, time management and communication skills.
    • Exceptional leadership and project management skills.
    • Strong conflict resolution and independent decision-making skills.
    • Excellent influencing, negotiation and analytical skills.
    • Knowledge of the principles of Quality and Care Management. For additional information and/or confidential consideration, please contact:

Keywords: The French Group, Philadelphia , MEDICARE MEDICAL DIRECTOR, Executive , Philadelphia, Pennsylvania

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Associate Director, CMC Documentation
Description: At Bristol Myers Squibb, we are inspired by a single vision - transforming patients' lives through science.--In oncology, hematology, immunology and cardiovascular disease - and one of the most diverse (more...)
Company: Adecco Group
Location: New Brunswick
Posted on: 02/26/2021

Case Manager/ Clinical Manager
Description: Independently owned non-medical home care agency is seeking a Case Manager/ Clinical Manager to provide a wide range of in-home services throughout central PA. br br Responsibilities br br li (more...)
Company: HealthCare Recruiters International
Location: Lancaster
Posted on: 02/26/2021

Management of Change Lead
Description: Location: New Brunswick, NJ Description: Our large fortune 500 pharmaceutical client is currently seeking a Management of Change Lead. W2 Only Please send resume to This job will have the following responsibilities: (more...)
Company: The Judge Group
Location: New Brunswick
Posted on: 02/26/2021


Program Manager
Description: Job Title: Program ManagerLocation: Hoboken, NJ br We are in one of the most dynamic periods in our history as technology globalism and economic diversity create far-reaching changes in the world. (more...)
Company: Wiley
Location: Hoboken
Posted on: 02/26/2021

VP of Engineering
Description: MPI does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, marital
Company: Michael Page
Location: Hoboken
Posted on: 02/26/2021

Director of Psychiatry (Physician #)
Description: A nonprofit healthcare agency in Westchester County is currently seeking a licensed Psychiatrist for a promising opportunity
Company: THE EXECU-SEARCH GROUP
Location: Mount Vernon
Posted on: 02/26/2021

Director of Care in Main Street Terrace at Revera Inc
Description: Director of Care in Main Street Terrace at Revera Inc Revera is a leading provider of seniors' accommodation, care and services built on a more than 50-year history of helping seniors live life to the (more...)
Company: Revera Inc.
Location: Lancaster
Posted on: 02/26/2021

Assistant Manager - Retail - Full Time
Description: GROW With US br br For 30 years Hudson Group has led the way and prides itself in knowing what matters in travel retail. As airports and transportation terminals have evolved, so has Hudson Group, (more...)
Company: Hudson Group
Location: Harrisburg
Posted on: 02/26/2021

Director Emergency Management & Business Continuity
Description: br American Association of Integrated br Healthcare Delivery Systems Join Our Email List br and receive FREE publications br AAIHDS will never sell your email Search AAIHDS Site: br ul (more...)
Company: American Association of Integrated Healthcare Deli
Location: Lancaster
Posted on: 02/26/2021

Sr. Manager, Formulation Research & Development
Description: Job DescriptionRenaissance LLC All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, (more...)
Company: renaissance llc
Location: Lakewood
Posted on: 02/26/2021

Log In or Create An Account

Get the latest Pennsylvania jobs by following @recnetPA on Twitter!

Philadelphia RSS job feeds